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Patient Safety Learning

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  1. Patient Safety Learning
    In a new trial, cancer patients across the UK have been using the eRAPID technology system to help them manage their cancer symptoms.
    The system has been developed by the University of Leeds, and this is the first trial to offer automated advice to early-stage patients whose treatment aims to cure cancer. Hundreds of early-stage colorectal, breast, or gynaecological cancer patients took part in the trial which used computer algorithms to help manage their symptoms and improve their wellbeing. They were able to report online symptoms from home and receive instant advice on whether to self-manage or seek medical attention.
    Cancer can cause a range of different symptoms for patients living with the disease, as well as from the side effects of treatments such as chemotherapy, which are sometimes life-threatening and all of which lower a patients’ quality of life. Better monitoring and management of these symptoms can help in improving treatment delivery and reducing patients’ physical distress.
    All patients in the trial received their usual care, with 256 receiving the eRAPID system as additional care. The patients reported better symptom control and physical wellbeing in the early weeks of treatment, with the system preventing symptom deterioration in about 9% of patients after 12 weeks.
    Dr Kate Absolom, University Academic Fellow in the Leeds Institute of Medical Research at St James’s and the Leeds Institute of Health Sciences at the University of Leeds, said: “The encouraging results from this study will help pave the way for future development and refinement of these interventions in broader cancer settings. The COVID-19 pandemic highlighted the need and speeded a shift towards technology-enabled care, so these study results are very timely.”
    Programme lead Professor Galina Velikova, at the Leeds Institute of Medical Research at St James’s, University of Leeds, and the Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, said: “Rising numbers of cancer patients are receiving a range of anti-cancer treatments which means patients are living longer and require longer periods of care and monitoring.
    “Remote online monitoring options have the potential to be a patient-centred, safe, and effective approach to support patients during cancer treatment and manage the growing clinical workload for cancer care.”
    Read full story
    Source: Health Europa, 11 January 2021
  2. Patient Safety Learning
    Hospitals should ramp up their treatment of COVID-19 patients at home to free up more beds during the peak of the pandemic, under plans announced by NHS England/Improvement.
    All NHS trusts will receive up to 300 oximeters, which measure oxygen saturation levels and can be used to monitor COVID-19 patients in their own homes, rather than in hospital beds.
    NHSE has “recommended” that all areas of England “pursue immediate roll-out” given the “intense pressure on hospital beds right now”, according to a letter from medical director Steve Powis and two other national directors.
    Currently, nearly 60 trusts have COVID-19 patients in at least a third or more of their beds, and the total number of COVID-19 patients is peaking at around 37,000. There have been particular strains on hospital discharge, particularly of covid patients, whom many care homes are unable or unwilling to receive.
    The scheme, dubbed “covid virtual wards”, has been used at some trusts since the pandemic’s first wave.
    Read full story (paywalled)
    Source: HSJ, 19 January 2021
  3. Patient Safety Learning
    Doctors and midwives working in maternity services face higher levels of bullying than any other part of the NHS, MPs have been told.
    According to the General Medical Council, trainee doctors in maternity services report more than twice the level of bullying seen in the rest of the NHS while the Nursing and Midwifery Council said midwives were also more likely to be bullied.
    MPs on the Commons health select committee heard that the culture in some maternity units was a major barrier to improving safety and tackling poor care.
    In an evidence session as part of an ongoing inquiry into maternity care, MPs were also warned the lack of properly funded training was forcing some midwives to pay out of their own pocket.
    The inquiry by the committee was launched last year after repeated maternity scandals at the Shrewsbury and Telford Hospitals Trust and East Kent Hospitals University Trust.
    Giving evidence to the committee, Charlie Massey, chief executive of the General Medical Council said: “We do see in our data some quite troubling data around bullying."
    “If you are an obstetrics or gynaecology trainee, we see in our national training survey each year that some 14% report that they have experienced bullying – and that’s against an average for all trainees of 6%. You see more than double the rate of bullying in obstetrics and gynaecology than you do elsewhere.”
    Read full story
    Source: The Independent, 20 January 2021
  4. Patient Safety Learning
    There has been a sharp drop in the number of patients admitted to hospitals in England with heart attacks or heart failure in recent months, research reveals.
    Experts are worried that people who need urgent medical help are not seeking it. This was also the case during the first wave of the pandemic.
    The researchers included 66 hospitals in the study and compared daily admission rates in the year before the pandemic with those during the first and second waves in England, up to 17 November.
    During the first lockdown, daily admissions for heart attacks or heart failure decreased by more than 50%. They went up again in the summer, as coronavirus rates decreased in the UK and the NHS became less busy with the virus.
    From October, when coronavirus cases were rising again, heart admissions began to drop - by between 35% and 41% compared with pre-pandemic data, according to the study published in the Journal of the American College of Cardiology.
    Researcher Prof Chris Gale, from Leeds University, said: "Medical emergencies do not stop in a pandemic. I am afraid that we are seeing a re-run of one of the preventable tragedies of the first wave - people were either too afraid to go to hospital for fear of contracting COVIDd-19 or were not referred for treatment."
    "The message to patients needs to be clear. If they experience symptoms of a heart attack or acute heart failure, they need to attend hospital."
    Read full story
    Source: BBC News, 20 January 2021
  5. Patient Safety Learning
    The UK’s main gender identity development service for children is leaving thousands of vulnerable young people at risk of self-harm as they wait years for their first appointment, according to a highly critical report.
    The Care Quality Commission (CQC) took immediate enforcement action against the Tavistock and Portman NHS foundation trust when it completed the inspection in November, which rated the service overall “inadequate” and highlighted overwhelming caseloads, deficient record-keeping and poor leadership.
    The commission, which heard from young people using the service, parents, carers and staff in the course of its inspection, told the trust that services and waiting times in the Gender Identity Development Services (GIDS) in both their London and Leeds clinics “must improve significantly”, demanding monthly updates on numbers on waiting lists and actions to reduce them.
    The service has faced major scrutiny in recent years, with some former staff and campaigners raising concerns about the “overdiagnosing” of gender dysphoria, the consequences of early medical interventions and the significant increase in referrals of girls questioning their gender identity.
    Read full story
    Source: The Guardian, 20 January 2021
  6. Patient Safety Learning
    The family of a man who bled to death during kidney dialysis treatment at Royal Shrewsbury Hospital have said they believe lessons have been learned.
    Mohammed Ismael Zaman, known as Bolly, died after hospital staff failed to check the connection on his dialysis machine, despite it sounding an alarm after the catheter had become disconnected.
    During Mr Zaman’s treatment at the Royal Shrewsbury Hospital on October 18, 2019, his dialysis machine set off a venous pressure alarm.
    An unidentified member of staff reset the alarm without checking that the connection was still secure. As a result of the reset, Mr Zaman bled out for seven minutes losing 49% of his blood circulating volume.
    He was found unconscious in a pool of blood and despite resuscitation attempts, died two hours later.
    The coroner, Mr John Ellery concluded that the death was due to systems failure and individual neglect on the part of the unidentified staff member.
    Read full story
    Source: Shropshire Star, 16 January 2021
  7. Patient Safety Learning
    A London hospital is being forced to send patients back to ambulances for treatment due to an ‘overwhelming’ number of Covid patients on ICU wards, according to a frontline doctor.
    The medic, who asked to remain anonymous, said A&E staff are "running" into waiting ambulances to treat patients there until space becomes available.
    He said: "It’s not the fault of the staff, but the sheer numbers are so unprecedented and being full like this means that you just have to do your best to adapt. But it’s not the standard (of care) I signed up to."
    "It’s extremely stressful for us to be doing our best but knowing that significant patient harm is happening because there isn’t space and the patient load is too high." 
    He raised concerns that "significant patient harm" was occurring due to a lack of beds available and the emergency system means medics are limited in the care they can provide.
    Read full story
    Source: The Metro, 14 January 2021
  8. Patient Safety Learning
    The growth in covid positive hospital patients is rapidly slowing in every English region and appears to have stopped in the south east.
    The weekly increase in covid inpatients across England fell to 8% yesterday, the first time it had dropped to single figures since 12 December. A week earlier, on 10 January, the growth rate stood at 23%.
    There are now 33,352 covid hospital patients in English hospitals, an increase of 2,594 in the last seven days. The previous week had seen a rise of 5,801.
    The weekly growth rate of covid positive hospital patients in the seven English regions currently ranges from 26% in the south west to zero in the south east. In every region, the growth rate is seven to 20 percentage points lower than recorded on 10 January.
    London’s weekly growth rate is now three per cent and the east’s is 2%. There has been no substantive change in the south east total in the past week. It is likely covid patients will be seen to have peaked in these three regions between 13 to 15 January.
    The slowing in the growth of national covid patient numbers means the total is likely to peak during the next seven days at a level lower than many had feared and expected. HSJ has seen internal NHS England projections from last week that saw growth continuing into February and total covid patient numbers rising well above 40,000, this now seem very unlikely.
    Read full story
    Source: HSJ, 18 January 2021
  9. Patient Safety Learning
    Emergency legislation is needed to protect doctors and nurses from “inappropriate” legal action over critical Covid treatment decisions made amid the pressures of the pandemic, health organisations have argued.
    A coalition of health bodies has written to Matt Hancock, the health secretary, calling for the law to be updated so medical workers do not feel “vulnerable to the risk of prosecution for unlawful killing” when treating coronavirus patients “in circumstances beyond their control”.
    The letter, coordinated by the Medical Protection Society (MPS), states there are no legal safeguards for coronavirus-related issues such as when there are “surges in demand for resources that temporarily exceed supply”.
    The coalition, which includes the British Medical Association and Doctors’ Association UK, wrote: “With the chief medical officers now determining that there is a material risk of the NHS being overwhelmed within weeks, our members are worried that not only do they face being put in this position but also that they could subsequently be vulnerable to a criminal investigation by the police.
    “There is no national guidance, backed up by a clear statement of law, on when life-sustaining treatment can be lawfully withheld or withdrawn from a patient in order for it to benefit a different patient, and if so under what conditions. The first concern of a doctor is their patients and providing the highest standard of care at all times.”
    Read full story
    Source: The Guardian, 16 January 2021
  10. Patient Safety Learning
    A mental health trust prosecuted for failings after 11 patients died must make further safety improvements, the Care Quality Commission (CQC) said.
    Inspectors found safety issues on male wards and psychiatric intensive care units run by Essex Partnership University NHS Foundation Trust (EPUT).
    The Trust said it had taken "immediate action" to remedy the concerns.
    In November, EPUT pleaded guilty to safety failings related to patient deaths between 2004 and 2015.
    The CQC's report followed inspections in October and November last year at the Finchingfield Ward - a 17-bed unit in the Linden Centre in Chelmsford which provides treatment for men experiencing acute mental health difficulties.
    The CQC said the visit was prompted "due to concerning information raised to the commission regarding safety incidents leading to concerns around risk of harm".
    The inspection, which looked at safety only, found the following concerns:
    Some staff did not follow the required actions to maintain patient safety. Closed-circuit television showed staff who were meant to be observing were not present, and this contributed to an incident of patient absconding. Staff did not keep accurate records of patient care and managers did not check the quality and accuracy. of notes. Shifts were not always covered by staff with appropriate experience and competency Stuart Dunn, head of hospital inspection at the CQC, said EPUT had "responded quickly to concerns raised" including improving security measures.
    Read full story
    Source: BBC News, 14 January 2021
  11. Patient Safety Learning
    Advisers from the Scientific Advisory Group for Emergencies (Sage) have raised fresh concerns over Covid vaccine uptake among black, Asian and minority ethnic communities (BAME) as research showed up to 72% of black people said they were unlikely to have the jab.
    Historical issues of unethical healthcare research, and structural and institutional racism and discrimination, are key reasons for lower levels of trust in the vaccination programme, a report from Sage said.
    The figures come from the UK Household Longitudinal Study, which conducts annual interviews to gain a long-term perspective on British people’s lives.
    In late November, the researchers contacted 12,035 participants to investigate the prevalence of coronavirus vaccine hesitancy in the UK, and whether certain subgroups were more likely to be affected by it. Overall, the study found high levels of willingness to be vaccinated, with 82% of people saying they were likely or very likely to have the jab – rising to 96% among people over the age of 75.
    Women, younger people and those with lower levels of education were less willing, but hesitancy was particularly high among people from black groups, where 72% said they were unlikely or very unlikely to be vaccinated. Among Pakistani and Bangladeshi groups this figure was 42%. Eastern European groups were also less willing.
    “Trust is particularly important for black communities that have low trust in healthcare organisations and research findings due to historical issues of unethical healthcare research,” said the Sage experts.
    “Trust is also undermined by structural and institutional racism and discrimination. Minority ethnic groups have historically been underrepresented within health research, including vaccines trials, which can influence trust in a particular vaccine being perceived as appropriate and safe, and concerns that immunisation research is not ethnically heterogenous.”
    Read full story
    Source: The Guardian, 16 January 2021
  12. Patient Safety Learning
    The UK government’s new policy of distributing rapid coronavirus tests to local authorities in England has divided the medical and scientific community, with some calling for the tests to be halted because they could falsely reassure people and increase the spread of COVID-19.
    Critics are also concerned that the policy, announced on Sunday 10 January, was being rolled out without sufficient provision for people who test positive, such as putting them in hotels and compensating them financially. Supporters say the tests are a valuable additional tool in public health interventions to identify new cases and suppress further transmission.
    Launching the new testing drive, England’s health and social care secretary, Matt Hancock, said, “With roughly a third of people who have coronavirus not showing symptoms, targeted asymptomatic testing and subsequent isolation is highly effective in breaking chains of transmission. Rapid, regular testing is led by local authorities who design programmes based on their in-depth knowledge of the local populations, so testing can have the greatest impact.”
    Read full story
    Source: BMJ, 12 January 2021
  13. Patient Safety Learning
    Hundreds of senior midwives are to be given new training to help improve culture and leadership across 126 NHS trusts.
    Patient safety minister Nadine Dorries said a new £500,000 maternity leadership programme would be rolled out later this year aimed at giving senior staff running maternity wards the skills and knowledge they need to boost culture and safety.
    Its one step towards improving the working relationships between midwives and obstetricians and follows the damning report by the Ockenden inquiry into decades of poor care at Shrewsbury and Telford Hospitals Trust.
    The report, published last month, highlighted leadership on maternity wards as a key factor in cases at the trust which led to preventable baby deaths and cases of neglect over many years.
    Announcing the fund, Nadine Dorries said: “The shocking and tragic findings of the Ockenden Review highlighted the importance of strengthening maternity leadership and oversight as well as fostering more collaborative approaches within maternity and neonatal services.
    “I’m pleased to announce a new training programme for NHS maternity leaders, which will empower nurses, midwives and obstetricians to get the best out of their teams, and deliver safe, world-class care to mothers and their babies.”
    Read full story
    Source: The Independent, 12 January 2021
    Government press release
  14. Patient Safety Learning
    Private hospitals are ‘pushing back’ on requests from NHS trusts to send them more NHS patients, following a change to the national contract with the independent sector, and amid high pressure from COVID-19.
    Manchester University Foundation Trust, one of the largest NHS providers, has reported difficulties in accessing capacity at its local Spire, BMI and Ramsay hospitals this month.
    It comes as the NHS is facing “unthinkable” pressures from coronavirus patients, with dozens of hospitals on the brink of being overwhelmed.
    Throughout most of 2020, the bulk of private providers in England were on a national block contract whereby the NHS could use as much capacity as it needed.
    But a new contract, agreed with oversight from the Treasury last month, is now in place between January and April, and only offers trusts a minimum volume of activity which equates to activity provided in October and November.
    Pressures on the NHS have since intensified to unprecedented levels, with many areas now in far greater need of the private capacity than they were two months ago.
    And there appears to be a misunderstanding or lack of clarity in some areas about the extent to which they can now call on private capacity.
    Read full story (paywalled)
    Source: HSJ, 13 January 2021
  15. Patient Safety Learning
    A large-scale trial of a new treatment it is hoped will help stop COVID-19 patients from developing severe illness has begun in the UK.
    The first patient received the treatment at Hull Royal Infirmary on Tuesday afternoon. It involves inhaling a protein called interferon beta which the body produces when it gets a viral infection.
    The hope is it will stimulate the immune system, priming cells to be ready to fight off viruses.
    Early findings suggested the treatment cut the odds of a COVID-19 patient in hospital developing severe disease - such as requiring ventilation - by almost 80%.
    It was developed at Southampton University Hospital and is being produced by the Southampton-based biotech company, Synairgen.
    Read full story
    Source: BBC News, 13 January 2021
  16. Patient Safety Learning
    More women may suffer pain due to being conscious while undergoing caesareans or other pregnancy-related surgery under general anaesthetic than realised, a troubling new study has found.
    The report, conducted by medical journal Anaesthesia, found being awake while having a caesarean is far more common than it is with other types of surgery. 
    Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit.
    If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said.
    While the experiences generally only last for a few seconds or minutes, anaesthetists remain highly concerned.
    Women also felt tugging, stitching, feelings of dissociation and not being able to breathe - with some suffering long-term psychological damage that often involved characteristics of post-traumatic stress disorder.
    Read full story
    Source: The Independent, 13 January 2021
  17. Patient Safety Learning
    Many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience, a study suggests.
    Researchers at King's College London asked 709 workers at nine intensive care units in England about how they were coping as the first wave eased. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead".
    Nursing staff were more likely to report feelings of distress than doctors or other clinical staff in the anonymous web-based survey, which was carried out in June and July last year. Just over half reported good well-being.
    Victoria Sullivan, an intensive care nurse at Queen's Hospital in Romford, said she often can't sleep because she's thinking about what is happening at the hospital.
    Her worst moment was breaking the news of a death on the phone, she said, adding that the screams from the patient's relatives "will honestly stay with me forever".
    "Telling someone over the phone and all you can say is 'I'm really sorry', whilst they're crying their heart out, is quite traumatising," she said. "Although you're saying how sorry you are, in the back of your mind, you're also thinking: 'I've got three other patients I've got to go and see, the infusions need drawing up, and meds need to be given and a nurse needs support'.
    "The guilt is just too much."
    Lead researcher Prof Neil Greenberg said the findings should be a "wake-up call" for NHS managers. He said: "The severity of symptoms we identified are highly likely to impair some ICU staff's ability to provide high-quality care as well as negatively impacting on their quality of life."
    Read full story
    Source: BBC News, 13 January 2021
  18. Patient Safety Learning
    There is a considerable human and healthcare cost that could have been avoided at the onset of COVID-19 had more been done to ameliorate eventual racial health disparities, amounting to thousands of lives lost and billions of dollars spent, according to analysis from Altarum on behalf of Episcopal Health Foundation.
    Using figures up until the end of September 2020, the researchers found that had Black and Hispanic people in Texas been hospitalised at the same rate as their White counterparts, the state would have seen 24,000 fewer hospitalisations. That would have amounted to $550 million in healthcare cost savings, the analysis showed.
    That is not to mention the human costs associated with racial health disparities during the pandemic. Had Black and Hispanic patients had the same COVID-19 mortality rates as White people, the state of Texas would have seen about 5,000 fewer deaths, cutting the total number of COVID-19 deaths in the state by 30%.
    “These numbers are a glaring reminder of how non-medical factors like economic status and living conditions impact health and how COVID-19 is highlighting that in the worst way,” Elena Marks, president and CEO of the Episcopal Health Foundation, said in a statement. “The human and economic costs of health disparities continue to grow during the pandemic and we’re learning why we can’t address them through medicine alone. Something has to change in Texas.”
    Read full story
    Source: Patient Engagement HIT, 13 January 2021
  19. Patient Safety Learning
    More than a third of critical care units in the East of England are either at or have exceeded their maximum surge capacity, information leaked to HSJ reveals, and all but one are above their normal capacity.
    Data from the region’s critical care network shows that as of 11 January, seven of the region’s 19 critical care units were either at 100% of, or had exceeded, what is known as ”maximum safe surge” capacity. This represents the limit of safe care, mostly based on available staffing levels. The units have opened more beds, but they require dilution of normal staffing levels.
    Across the East of England, 482 of the region’s current 491 intensive care beds, after the opening of surge capacity, were occupied. This included 390 patients in intensive care with confirmed covid-19, six with suspected covid and 86 non-covid patients.
    It gives a regional occupancy rate of 91 per cent against total “safe surge” capacity.
    Published government figures show the rapid increase in demand for intensive care in the East of England in the last two weeks — the number of patients with covid in mechanical ventilation beds is more than double what it was just after Christmas.
    Read full story (paywalled)
    Source: HSJ, 11 January 2021
  20. Patient Safety Learning
    Thousands of women have had abortions after falling pregnant while having difficulties accessing contraception during the pandemic, healthcare providers have warned.
    Sexual health clinics have been forced to shut or run reduced services while staff are transferred to work with Covid patients or have to self-isolate – with the profound disruption leaving many women unable to access their usual methods of contraception.
    Many women are struggling to get the most effective long-acting contraceptive choices of a coil or an implant due to these requiring face-to-face appointments which have largely been suspended as consultations are carried out remotely via phone or video call to curb the spread of COVID-19.
    British Pregnancy Advisory Service, the UK's largest abortion provider, told The Independent they provided the progestogen-only contraceptive pill to almost 10,000 women undergoing an abortion between May and October last year.
    Katherine O’Brien, a spokesperson for the service, said: “Many of these women will have fallen pregnant after struggling to access contraception, so there really is a huge unmet need for contraceptive services which will only worsen as lockdown and Covid continues.
    “We routinely hear from women during the pandemic who simply can’t access their regular method of contraception because of clinics closing or staff being deployed elsewhere or staff self-isolating.”
    Read full story
    Source: The Independent, 9 January 2021
  21. Patient Safety Learning
    A coronavirus patient's gut bacteria may influence the length and severity of their infection and their immune response to it, a new study suggests. A team of researchers at The Chinese University of Hong Kong examined whether the variety and quantity of microbiome played a role in COVID-19 infections.
    Researchers found that patients with COVID-19 were depleted in gut bacteria known to modify a person's immune response, and that this depletion appeared to persist 30 days after the virus had gone.
    Gut bacteria — or gut microbiome — help to digest food. But research increasingly shows that gut bacteria also affect our health.
    The study, published in the journal Gut, found that the composition of gut microbiome had changed in COVID-19 patients, compared to those who did not have the infection.
    It said that gut microbiome could be involved in the "magnitude of COVID-19 severity possibly via modulating host immune responses".
    Read full story
    Source: The Independent, 12 January 2021
     
  22. Patient Safety Learning
    UK residents can apply for a Global Health Insurance Card (GHIC) to access emergency medical care in the EU when their current EHIC card runs out.
    Under a new agreement with the EU, both cards will offer equivalent healthcare protection when people are on holiday, studying or travelling for business. This includes emergency treatment as well as treatment needed for a pre-existing condition.
    The new GHIC card is free and can be obtained via the official GHIC website.
    Current European Health Insurance Cards (EHIC) are valid as long as they are in date, and can continue to be used when travelling to the EU. 
    You don't need to apply for a GHIC until your current EHIC expires. People should apply at least two weeks before they plan to travel to ensure their card arrives on time.
    Read full story
    Source: BBC News, 11 January 2021
  23. Patient Safety Learning
    GPs are being paid £1,000 to cancel second dose appointments for Covid jabs and given a script to follow to deal with angry patients amid growing chaos in the roll-out of the vaccine programme.
    Practices have been offered the payments to cover the workload of postponing hundreds of patients who were set to have their second dose and booking new ones in their place.
    NHS sources said the shift has contributed to delays in rolling out the programme. Some GPs have refused to postpone the appointments, with practice managers saying it was "too cruel" to dash the hopes of those who were booked for a second jab.
    In December, everyone given a first vaccine by Pfizer was told to come back for their second dose three weeks later. But the strategy was changed 10 days ago in a bid to get a first dose to more of the population more quickly.
    Patients are now being told they will have to wait 12 weeks for the second dose, with a reassurance from health officials that the longer gap could strengthen its effectiveness.
    By the time the plan was changed, around one million people had already been booked in for their second dose. GPs are now under orders to postpone such appointments and instead give the slots to those awaiting a first dose. 
    Read full story
    Source: The Telegraph, 8 January 2021
  24. Patient Safety Learning
    NHS England has told hospitals in the Midlands to further dilute their staffing ratios so critical care capacity can be doubled, HSJ has learned.
    In a letter sent on 9 January to the boards of all trusts in the region, national leaders said they needed to “dilute nursing ratios beyond the current ask of 1:2” to achieve the significant increase in capacity.
    In November, all trusts in England were told they could dilute staffing ratios in critical care from the standard one nurse to one patient ratio, to one nurse to two patients. Informal reports from around the country suggest some trusts have already had to move beyond these ratios.
    The letter said trusts had already been asked to surge capacity to 150% cent of the normal baseline on 6 January, and were expected to be at 175% today. But it said some units were still not achieving this and the region was “transferring patients to other regions.”
    It added: “In addition to this, you need to have well developed plans in place that can be rapidly activated to surge to 200% of baseline, which may need to be enacted in the coming days.
    Read full story (paywalled)
    Source: HSJ, 11 January 2021
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