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Keep up to date with the latest news, research and activity in patient safety.

Inside an ICU: how long can we stay calm in the face of the coronavirus crisis?

Matt Morgan, an intensive care doctor, describes in this Guardian article how his ICU are preparing for the coronavirus crisis.
"ICUs are as prepared as they can be. Locally business as usual has made way for preparations for caring for high numbers of patients. We are finding every ventilator we may have and identifying every suitably qualified member of staff. We will work together to fill gaps as best we can.
There’s a sense of anticipation about what the next eight, 10, 12 weeks are going to bring in terms of work. Anyone who works in healthcare is also a mum, dad, daughter, brother, son. We want to give everything to saving lives and work and care, but equally we’re thinking about the logistics of personal lives and elderly relatives too."
Matt says his worst nightmare is having insufficient workforce and equipment to meet patient needs. Whether or not that will come to fruition is tough to predict. 
He also says that his ICU has a psychologist who’s doing a huge amount of thinking about putting in place wellbeing resources for staff who might be in moral distress after having to prioritise one patient over another.
"If there are 500 patients and only 200 ventilators then that’s when we need national guidance from the government and other bodies. It can’t be up to individual doctors. The age of playing God is long behind us. The question is who should we be making decisions with: the public, government or within the profession?"
Read full story
Source: The Guardian, 13 March 2020
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CQC suspends routine inspections amid covid-19 outbreak

The Care Quality Commission (CQC) has suspended its routine inspections due to the coronavirus outbreak following pressure from system leaders and NHS bosses.
The decision to suspend inspections where there are no immediate safety concerns is understood to have been taken by the CQC’s executive team this morning, senior sources told HSJ. Both the NHS Confederation and The Royal College of GPs said the decision had been made.
NHS Confederation called the move a “sigh of relief” for front-line staff, while the RCGPs said it would enable GPs to dedicate their time to providing care. 
NHS Confederation chief executive Niall Dickson said: “Front-line staff will breathe a sigh of relief that CQC has responded to our concerns and will now postpone its inspections where there is no immediate safety concern so that they can gear themselves up to prepare for the huge task ahead in dealing with the coronavirus pandemic.”
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Source: HSJ, 16 March 2020
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Why frontline health workers may not be tested for coronavirus even if they have symptoms

Channel 4 News says they have seen a Public Health England document indicating that not all healthcare and other essential workers with symptoms will be tested because there simply isn’t the capacity to do so – with testing prioritised in order of clinical need.
Public Health England say they won’t comment on the contents of a leaked document and it is still subject to ongoing discussions.
View full story
Source: Channel 4 News, 15 March 2020
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Health experts criticise NHS advice to take ibuprofen for Covid-19

Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition.
The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”
NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen.
“I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.”
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Source: The Guardian, 16 March 2020
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Coronavirus: PM says everyone should avoid office, pubs and travelling

The Prime Minister has said everyone in the UK should avoid "non-essential" travel and contact with others to curb coronavirus as the country's death toll hit 55.
Boris Johnson said people should work from home where possible as part of a range of stringent new measures, which include:
1. Everyone of every age should avoid any non-essential social contact and travel.
2. Everyone to avoid pubs, clubs, cinemas, theatres and restaurants etc.
3. Everyone to avoid large gatherings - including sports events.
4. Everyone should work from home where possible.
5. If anyone in a house has CV19 symptoms, everyone in that house has to isolate for at least 14 days
6. Over 70s and those at risk (including pregnant women) to stay home for 12 weeks, which means no going out to shops or collect anything etc., unless there is no other option.
Schools will not close for the moment. 
Read full story
Source: BBC News, 16 March 2020
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Child deaths 'not properly investigated' at top hospital

Great Ormond Street Hospital (GOSH) failed to properly investigate child deaths, suggests evidence uncovered by the BBC.
The source of one fatal infection was never examined and in another case GOSH concealed internal doubts over care. Amid claims GOSH put reputation above patient care, former Health Secretary Jeremy Hunt urged it to consider a possible "profound cultural problem".
Responding, the central London hospital said it rejected all suggestions that it treated any child's death lightly.
BBC Radio 4's File on 4 programme has spoken to several families whose children were treated at the world-famous hospital. All said that while care at one point had been excellent, when things went wrong GOSH appeared to have little interest in fully understanding what had happened.
The concerns over how Great Ormond Street is run are shared by staff. A staff survey, published last month, made grim reading for management.
On two aspects, including whether there is a safety culture, it received the lowest score of all trusts in its category, while on three other questions, including how bad bullying and harassment were, and how good the quality of care was, its own staff rated it as among the worst.
"If we want the NHS to offer the highest quality care in the world, then we have to change a blame culture and sometimes a bullying culture, for a learning and an improvement culture," the former Health Secretary Jeremy Hunt told File on 4.
"That staff survey would indicate they don't have that culture at Great Ormond Street."
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Source: BBC News, 17 March 2020
Read Joanne Hughes' response to this news in her blog shared on the hub.
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On the front lines of coronavirus: the Italian response to covid-19

Italy has rapidly become the country hit second hardest in the world by the coronavirus pandemic. Marta Paterlini reports in the BMJ on the front lines of a country in total lockdown.
The resulting government imposed state of emergency lockdown, which started in northern Italy and has expanded to the whole country, will last until at least 3 April in an attempt to contain a contagion that has, at the time of writing, infected over 24 747 people (including at least 2026 healthcare staff) and killed 1809. The fatality rate of 7.2 is now higher than in China (3.8).
Italian doctors describe a warlike scenario in hospitals, with fewer places available than there are patients in critical condition. Lombardy, the region around Milan and the most affected in the country, has around 1000 beds available for patients in need of intensive care, but they are near to saturation.
Italy is experiencing a chronic shortage of healthcare workers. On 9 March the government announced a plan to add 20 000 new doctors, nurses, and hospital employees to meet demand.567 Retired doctors may be called on, as well as students who have completed their medical degree and are in the final year of specialist training.
Meanwhile, medical authorities are trying to avoid quarantining doctors who have come into contact with coronavirus patients. They are encouraged to work unless they show symptoms of the infection or test positive. Specialist physicians such as gastroenterologists and cardiologists have been asked to work outside of their fields.
Read full story
Source: BMJ, 16 March 2020
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'Not fit for purpose': UK medics condemn Covid-19 protection

Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded last week, doctors and nurses have warned.
Hospital staff caring for the growing number of those seriously ill with the disease also fear that they could pass the infection on to other patients after catching it at work because of poor protection.
Doctors who are dealing most closely with Covid-19 patients – A&E medics, anaesthetists and specialists in acute medicine and intensive care – are most worried.
A doctor in an infectious diseases ward of a major UK hospital, who is treating patients with Covid-19, said: “I am terrified. I am seriously considering whether I can keep working as a doctor.”
Read full story
Source: The Guardian, 16 March 2020
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Coronavirus: Routine NHS operations cancelled in effort to free up 30,000 hospital beds

NHS hospitals have been told to cancel operations in an effort to free up 30,000 beds to create space for an expected surge in coronavirus patients.
In a letter to NHS bosses today, NHS England said hospitals should look to cancel all non-urgent surgeries for at least three months starting from 15 April. 
Hospitals were given discretion to begin winding down activity immediately to help train staff and begin work setting up makeshift intensive care wards. Any cancer operations and patients needing emergency treatment will not be affected.
The letter from NHS England Chief Executive Simon Stevens said: “The operational aim is to expand critical care capacity to the maximum; free up 30,000 (or more) of the English NHS’s 100,000 general and acute beds."
In the meantime hospitals were told to do as much elective surgery, such as hip operations and knee replacements, as possible and to use private sector hospitals which it said could free up 12 to 15,000 beds across England.
Sir Simon also said patients who did not need to be in hospital should be discharged as quickly as possible adding: “Community health providers must take immediate full responsibility for urgent discharge of all eligible patients identified by acute providers on a discharge list. For those needing social care, emergency legislation before Parliament this week will ensure that eligibility assessments do not delay discharge.
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Source: The Independent, 17 March 2020
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NHS staff ‘can access covid-19 testing’, government insists

NHS staff are to be given access to testing for covid-19, the government said this morning, but it remains unclear how the policy will be applied.
A Department of Health and Social Care spokesman said at lunchtime: “Our testing regime is set up to provide for those who need tests the most. This includes key workers, such as NHS staff. We will set out more details shortly.”
It remains unclear how this will be applied.
The announcement follows concerns from healthcare professionals they are not being tested for the virus, even if they had been exposed to infected patients.
Read full story (paywalled)
Source: HSJ, 17 March 2020
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Coronavirus: UK changes course amid death toll fears

Change course or a quarter of a million people will die in a "catastrophic epidemic" of coronavirus – warnings do not come much starker than that.
The message came from researchers modelling how the disease will spread, how the NHS would be overwhelmed and how many would die. The situation has shifted dramatically and as a result we are now facing the most profound changes to our daily lives in peacetime.
This realisation has happened only in the past few days.
However, it is long after other scientists and the World Health Organization had warned of the risks of not going all-out to stop the virus.
Read full story 
Source: BBC News, 18 March 2020
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Covid-19: Ibuprofen should not be used for managing symptoms, say doctors and scientists

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of COVID-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.
The minister, Oliver Veran, tweeted on Saturday 14 March that people with suspected COVID-19 should avoid anti-inflammatory drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone . . .) could be an aggravating factor for the infection. If you have a fever, take paracetamol,” he said.
Jean-Louis Montastruc, Professor of Medical and Clinical Pharmacology at the Central University Hospital in Toulouse, said that such deleterious effects from NSAIDS would not be a surprise given that since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen.
Experts in the UK backed this sentiment. Paul Little, Professor of Primary Care Research at the University of Southampton, said that there was good evidence “that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used—both respiratory or septic complications and cardiovascular complications.”
Read full story
Source: BMJ, 17 March 2020
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Coronavirus: Australian scientists map how immune system fights virus

Scientists in Australia say they have identified how the body's immune system fights the Covid-19 virus.
Their research, published in Nature Medicine journal on Tuesday, shows people are recovering from the new virus like they would from the flu.
Determining which immune cells are appearing should also help with vaccine development, experts say.
"This [discovery] is important because it is the first time where we are really understanding how our immune system fights novel coronavirus," said study co-author Prof Katherine Kedzierska.
The research by Melbourne's Peter Doherty Institute for Infection and Immunity has been praised by other experts, with one calling it "a breakthrough".
Read full story
Source: BBC News, 17 March 2020
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Testing for coronavirus: what is being done in the UK?

Who is being tested for coronavirus in the UK? 
As of last week, when the Prime Minister announced Britain was no longer in the “contain” phase of the pandemic, most testing outside of hospitals stopped. People with symptoms are expected to self-isolate but will not know whether they have COVID-19. That means they will not know if they are immune or still at risk – and a risk to other people.
Testing now mostly takes place in hospital. People in intensive care units and those with respiratory illness, especially if it is pneumonia, will get tested for COVID-19. When there is a cluster of infections, such as an outbreak in a care home, those people will also be tested.
But the World Health Organization has criticised the approach of countries that are not prioritising testing, with its director general saying “you cannot fight a fire blindfolded … test, test, test”.
So why are people with symptoms not being tested?
It appears to be a capacity issue, although the Department of Health and Social Care failed to respond to repeated requests for explanation. So far there have been about 44,000 tests in England, which the government’s chief scientific adviser, Sir Patrick Vallance, told the health select committee put it in “the top three or four countries in terms of testing”.
Read full story
Source: BBC News, 17 March 2020
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Coronavirus spread has ‘kicked NHS forward in adopting digital solutions’

The rapid spread of coronavirus has given the NHS a “kick forward” in the need to accelerate technology and ensure staff are digitally prepared, a GP has said.
Neil Paul, a Digital Health columnist and GP in Ashfields, said the need to reduce face-to-face appointments to prevent the potential transmission of Covid-19 has forced the NHS, particularly in primary care, to adopt already available technologies.
He said practices “still in the stone ages” and “technophobes” were less prepared for the current situation, but that it would force them to move into the digital age.
“It’s absolutely made my surgery go ‘right, how do we do online consults’. I think it actually has given people a real kick forward,” he told Digital Health News.
“I think in six months’ time my surgery might be very different in that actually we will be doing a lot of online and telephone consults where previously we may have been a bit reluctant."
GP practices across the country have been advised to assess patients online or via telephone and video appointments to mitigate the potential spread of coronavirus.
In a letter to GPs last week, NHS England urged Britain’s 7,000 GP surgeries to reduce face-to-face appoints for patients displaying symptoms of Covid-19. The preemptive move means millions of patients will now be triaged online, via telephone or video and contacted via text messaging services.
Read full story
Source: Digital Health News, 13 March 2020
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NHS COVID-19 live impact assessment tool launched

Draper & Dash, a leading predictive patient flow provider, has launched a COVID-19 live hospital planning and demand impact assessment tool.
The company said it has been working around the clock to deliver its vital tool to support impact assessment. It allows trusts to view and analyse national Hospital Episode Statistics (HES) data, alongside a number of live data sources on COVID-19 cases by the minute, as they emerge across the globe.
The system models the impact of increased volume and complexity at a local and system level, providing visibility of ICU, theatres, and overall bed impact, and connects this live information to each trust’s clinical workforce. The tool shows immediate impacts on beds and staff under a range of selected scenarios.
Read full story
Source: Health Tech Newspaper, 18 March 2020
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