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

London begins major COVID-19 reconfiguration

St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak.
Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan.
It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients.
The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months.
Read full story (paywalled)
Source: HSJ, 18 March 2020
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Coronavirus testing: What is the UK government's plan?

Prime Minister Boris Johnson has announced plans to test more people for coronavirus.
At the moment only people in hospital are being routinely tested, so if you have symptoms and you are not sure if you have the virus, you may well never know.
As of 18 March, 56,221 people in the UK had been tested for coronavirus. The number of tests has been rising from just over 1,000 a day at the end of February, when testing began, to more than 6,000 per day by mid-March.
The government plans to increase this to 10,000 a day initially, with a goal of reaching 25,000 tests a day. But it has been criticised by some experts for not testing widely enough, and people have been complaining online about not having access to tests despite having symptoms.
Public Health England says it will do some surveillance testing on a local level if clusters of cases are identified, using a network of 100 designated GP surgeries. This is to try to get a sense of how many milder cases there are in the community that do not result in hospitalisation.
But the UK is not currently doing any mass surveillance testing or actively tracing people who have come into contact with known cases
The Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said he had a "simple message" for all countries: "Test, test, test."
He added: "We cannot stop this pandemic if we do not know who is infected."
The UK's chief scientific officer Sir Patrick Vallance told a group of MPs that "we simply don't have mass testing available for the population now", and that "when you only have capacity to do a certain number of tests" you have to prioritise the most vulnerable groups.
Read full story
Source: BBC News, 19 March 2020
Sam

NHS staff 'at risk' over lack of protective gear

NHS staff say they are being put at risk during the coronavirus outbreak because of a lack of protective gear.
One doctor told the BBC that frontline healthcare workers felt like "cannon fodder" as they do not have access to equipment such as face masks. Health workers also expressed concerns that not enough of them were being tested for the virus.
Prime Minister Boris Johnson said the UK had "stockpiles" of personal protective equipment (PPE). But Dr Samantha Batt-Rawden, from lobbying group the Doctors' Association, said she had heard from doctors who had not got access to PPE - or it had expired or run out.
"All these doctors are worried that that's increasing their likelihood of contracting the virus and then ultimately spreading it to patients," she said.
Read full story
Source: BBC News, 18 March 2020
Sam

Faculty of Medicine to lead drug trial into treatment of COVID-19

Southampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk.
The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part.
Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days.
The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic.
Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and  to help patients recover quickly as the pressure on health systems mounts."
Read full story
Source: University of Southampton, 18 March 2020
Sam

UK failures over Covid-19 will increase death toll, says leading doctor

A “collective failure” to appreciate the enormity of the coronavirus pandemic and enact swift measures to protect the public will lead to unnecessary deaths, according to a leading doctor who says the UK ignored clear warning signs from China.
Richard Horton, the Editor-in-Chief of the Lancet, rounded on politicians and their expert advisers for failing to act when Chinese researchers first warned about a devastating new virus that was killing people in Hubei eight weeks ago.
The team from Wuhan and Beijing reported in January that the number of deaths was rising quickly as the virus spread in China. They urged the global community to launch “careful surveillance” in view of the pathogen’s “pandemic potential”.
Horton said nothing in the science had changed since January. “The UK’s best scientists have known since that first report from China that Covid-19 was a lethal illness. Yet they did too little, too late,” he said.
While the UK was now taking the right actions to quell the outbreak, Horton said, in due course “there must be a reckoning” where difficult questions would have to be asked and answered. “We have lost valuable time. There will be deaths that were preventable. The system failed,” he said.
Read full story
Source: The Guardian, 18 March 2020
Patient Safety Learning

New coronavirus stable for hours on surfaces

COVID-19 is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine.
The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects.
The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2:
Avoid close contact with people who are sick. Avoid touching your eyes, nose, and mouth. Stay home when you are sick. Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Read full story
Source: National Institutes of Health, 17 March 2020
Patient Safety Learning

Trusts criticise ‘completely chaotic’ covid-19 supply response

Several trust procurement leads have expressed frustration with the government’s response to covid-19, with HSJ being told of shortages of crucial personal protective equipment, unpredictable deliveries and a lack of clarity from the centre
NHS Supply Chain, which procures common consumables and medical devices for trusts, has been “managing demand” for an increasing number of PPE and infection control products for since the end of February to ensure “continuity of supply”. Some products, like certain polymer aprons, are unavailable altogether because of the increased demand and disrupted supply caused by the covid-19 outbreak. 
One procurement lead told HSJ: “They aren’t supplying enough, they aren’t fulfilling orders. It’s completely chaotic.” Another said his trust had “just enough to manage for the time being.”
Read full story (paywalled)
Source: HSJ, 20 March 2020
Patient Safety Learning

UK government must recognise care workers are on the coronavirus frontline too

Social care has a vital part to play in the fight against Covid-19, but without proper support more lives will be put at risk, says Vic Rayner, Executive Director of the National Care Forum.
"We are working round the clock to keep the people we care for safe and happy and to protect our staff. We know the COVID-19 situation is moving fast – but the care sector can only effectively play its part with more direct support from the government."
Social care providers, like many across the country, are working hard to prepare for the escalation of COVID-19. This includes refresher training on infection control, robust measures to ensure any visitors to care services are safe to enter, planning for how to keep going in the face of significant workforce shortages, and ensuring the people they care for and their staff are kept safe and well.
However, it is clear that social care is in urgent need of help, more directly and more quickly, to meet the needs of the most vulnerable, or to ensure that their staff are adequately protected.
The issue of protection is never far from care providers’ minds, and the lack of personal protective equipment (PPE) for care staff remains a pressing problem.
Read full story
Source: The Guardian, 20 March 2020 
Patient Safety Learning

NHSX is working on a contact tracking App

NHSX is working on a contact tracking app to trace the spread of coronavirus through the population.
Contact tracking is already in limited use for people who have tested positive and the discipline has a long history in tuberculosis outbreaks.
In a statement sent to HSJ, Matthew Gould, Chief Executive of NHSX, said : “NHSX are looking at whether app-based solutions might be helpful in tracking and managing coronavirus, and we have assembled expertise from inside and outside the organisation to do this as rapidly as possible.”
Read full story (paywalled)
Source: HSJ, 18 March 2020
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Efforts to reduce stillbirths, deaths, and injuries in babies have failed, finds review

A campaign to reduce stillbirths, brain injury, and avoidable deaths in babies has failed to have any effect in the past three years, findings from the Royal College of Obstetricians and Gynaecologists show.
The president of the college, Edward Morris, has urged maternity units across the UK to learn from the latest report and act on its recommendations. “We owe it to each and every person affected to find out why these deaths and harms occur in order to prevent future cases where possible,” he said.
Read full story (paywalled)
Source: BMJ, 19 March 2020
Patient Safety Learning

Hospital’s critical care unit overwhelmed by coronavirus patients

A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”.
In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites.
The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19.
“This means that we currently do not have enough space for patients requiring critical care.
“As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site”
Read full story (paywalled)
Source: HSJ, 20 March 2020
Patient Safety Learning

Coronavirus: Doctors urge conversations about dying

Palliative care doctors are urging people to have a conversation about what they would want if they, or their loved ones, became seriously unwell with coronavirus.
We should discuss all possible scenarios - even those we are not "comfortable to talk about", they said. Medics said the virus underlined the importance of these conversations.
New guidelines are being produced for palliative care for Covid-19 patients, the BBC understands.
Read full story
Source: BBC News, 21 March 2020
Patient Safety Learning

Nurses treating coronavirus spat at and called ‘disease spreaders’

Nurses caring for patients in the community have been spat at and called ‘disease spreaders’ by members of the public, according to England’s chief nurse and the Royal College of Nursing (RCN).
The nursing union urged members of the public to support the UK’s “socially critical” nursing workforce during the coronavirus outbreak.
The RCN said it had received anecdotal reports of community nurses receiving abuse while working in uniform. Separately, England’s Chief Nurse Ruth May said she had heard reports of nurses being spat at.
Susan Masters, the RCN’s director of policy, said abuse of nurses was “abhorrent behaviour”. She said a number of nurses had raised concerns about abuse on forums used by members to talk confidentially.
Describing one incident she told The Independent: “These were community nurses who had to go into people’s homes and were in uniform. Members of the public who saw them called out to them and said they were ‘disease spreaders’.”
She added: “We don’t know how big this problem is, it is anecdotal, but it is absolutely unacceptable.
Read full story
Source: The Independent, 21 March 2020
Patient Safety Learning

Coronavirus: Hancock admits ‘challenges’ over NHS equipment

The health secretary has acknowledged there have been "challenges" with the supply of personal protective equipment to NHS staff in England - but added he is determined to rise to them.
Last week, NHS staff said the lack of protective gear was putting them at risk during the coronavirus outbreak.
Matt Hancock said a million face masks had been bought over the weekend and he was taking the issue "very seriously".
From this week, the Army will play a part in helping to distribute supplies.
"I am determined to ensure that the right kit gets to the right hospital, the right ambulance service, the right doctors' surgery, right across the country," said Mr Hancock.
"There have been challenges and I can see that. We're on it and trying to solve all the problems."
Read full story
Source: BBC News, 23 March 2020
Patient Safety Learning

Machine 'could quadruple' heart and lung transplants

The number of heart and lung transplants could quadruple thanks to a "reanimation" machine used in a pioneering operation, a hospital says.
The device, developed at Royal Papworth Hospital in Cambridge, managed to pump oxygenated blood into both organs in a world-first procedure. The machine can revitalise deteriorating organs allowing "donation after circulatory death" (DCD).
Hospital surgeon Pedro Catarino said it was like "recharging the batteries".
"It is reanimation and then it replenishes the energy stores of the heart, what we call reconditioning, which allows it be transplanted," he said. "We think it could at least double and perhaps quadruple the number of [heart and lungs] available for transplant."
He said it was desperately needed, adding: "Patients die on the waiting list every day."
Read full story
Source: BBC News, 23 March 2020
Patient Safety Learning

Coronavirus: Doctors given new guidelines on choosing which patients to treat in critical care

New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic.
The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators.
The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment.
They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”.
Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”.
Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care.
Read full story
Source: Independent, 22 March 2020
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