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Sam

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  1. News Article
    Serious patient safety and wellbeing concerns about the latest hospital discharge guidance have been raised to HSJ by senior clinicians and charities. Senior geriatricians warned that the guidance could prompt an increase in “urgent readmissions”, “permanent disability” and “excess mortality”, while charities said families could be left with “unsustainable caring responsibilities” because of the new rules. The government guidance, Hospital Discharge Service: policy and operating model, published in August, said clinicians should consider discharging patients when they were “medically optimised” rather than “medically fit”. It said 95% of these patients would return straight home with additional social care and rehabilitation support if needed. Many of the concerns raised surround the retention of the “criteria to reside”. This was originally agreed in March when there was a push from NHS England to free up acute beds over fears hospitals would become overwhelmed with covid admissions as the pandemic hit the UK. The criteria has, however, been maintained in the new guidance, despite a significant fall in infections and deaths from the virus. Rachel Power, chief executive of The Patients Association charity, warned: “This guidance makes it clear that the NHS is still having to take drastic emergency action in the face of covid-19, that will continue to take a heavy toll on patients. It is clear that many patients will be rushed home who would normally have had a longer period of hospital care.” Read full story (paywalled) Source: HSJ, 8 September 2020
  2. News Article
    Hundreds of women with breast cancer in London were not picked up by routine screening as services closed during the lockdown, officials have estimated. Data from NHS England and Improvement’s London office said it expected 450 people to have breast cancer and have gone undiagnosed because of the heavily reduced amount of screening at the height of the outbreak. It was included in a letter from officials to local health system leaders, seen by HSJ. It said the figure was an estimate based on the 115,000 routine breast screenings that would have taken place between late March and the end of June and which had to be re-scheduled. London represents around 15% of England’s population, so a nationwide estimate would run into thousands. Responding to the figures, Breast Cancer Now chief executive Baroness Delyth Morgan said: ”While it’s encouraging that the breast screening programme in London is now back up and running, we are concerned to hear of the hundreds of potential delayed cancer diagnoses as a result of disruption due to the pandemic. The earlier breast cancer is diagnosed, the more likely treatment is to be successful." “With over a hundred thousand people missing out on vital breast screening during the pandemic in London alone, we urge the government to ensure there is sufficient capacity in the already-stretched workforce to meet the huge backlog and to avoid any cancers going undetected for longer.” Read full story (paywalled) Source: HSJ, 9 September 2020
  3. News Article
    Thursday 17 September is WHO’s World Patient Safety Day. There’s no better moment in history to call for new legislation that finally ensures health worker and patient safety. Today, the Patient Safety Movement Foundation released a detailed white paper urging the creation of a National Patient Safety Board. In a statement, the Patient Safety Movement said COVID-19 has exposed the safety gaps in our healthcare system that already cause 200,000 deaths a year and that we must put health workers, and thus patients, first by finally establishing a National Patient Safety Board (NPSB). This would solve the problem in three key ways: Data-driven insight and standards: An NPSB would create and maintain a National Patient Safety Database to receive non-identifiable patient safety work product. The Board would facilitate the reporting, collection, and analysis of patient safety data and the development and dissemination of training guidelines and other recommendations to reduce medical errors and improve patient safety and quality of care. Transparency and accountability: The NPSB would also require an on-going analysis of the patient safety data in the Database and other available data to determine performance and systems standards, tools, and best practices (including peer review) for doctors and other health care providers necessary to prevent medical errors, improve patient safety, and increase accountability within the health care system. Align incentives: An NPSB would save lives and taxpayer dollars by aligning incentives, especially Medicare reimbursements, with proven patient safety protocols. "COVID-19 shouldn’t be the breaking point for our health workers, but it should be the breaking point for our tolerance of the lack of patient safety. Congress must act today on this bipartisan issue.” Read full story Source: The Patient Safety Movement, 8 September 2020
  4. Event
    This is the first of a series of webinars Patient Safety Learning, Health Plus Care and BD are holding on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline healthcare workers, clinical leaders and patient safety experts. COVID-19 has had a devastating impact on access to non-Covid care and treatment. We know there are over a million extra patients awaiting hospital treatment. The NHS has issued guidance for ‘accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter.’ In this webinar we will be discussing these issues with front-line clinicians and patient safety experts. Read Patient Safety Learning's accompanying blog that sets out some key points to inform the webinar. Registration
  5. News Article
    The development of a promising COVID-19 vaccine has been put on hold due to an adverse reaction in a trial participant. A spokesman for AstraZeneca, the company working with a team from Oxford University, told the Guardian the trial has been stopped to review the “potentially unexplained illness” in one of the participants. The spokesman stressed that the adverse reaction was only recorded in a single participant and said pausing trials was common during vaccine development. “As part of the ongoing randomised, controlled global trials of the Oxford coronavirus vaccine, our standard review process was triggered and we voluntarily paused vaccination to allow review of safety data by an independent committee,” the spokesman said. “This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials. In large trials illnesses will happen by chance but must be independently reviewed to check this carefully." “We are working to expedite the review of the single event to minimise any potential impact on the trial timeline. We are committed to the safety of our participants and the highest standards of conduct in our trials.” Read full story Source: The Guardian, 9 September 2020
  6. Event
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    This month's QI Connect session is with Michael West, Senior Fellow at The King's Fund. This special session on World Patient Safety Day is definitely one not to be missed! Register
  7. Event
    Cardiovascular disease (CVD) causes a quarter of all deaths in the UK and is the largest cause of premature mortality in deprived areas. The NHS long term plan identifies this as the biggest area where the NHS can save lives over the next 10 years. What do national plans and local work look like now, in the context of COVID-19? The HSJ Cardio Virtual Forum will bring together national and local leaders, senior managers, clinicians, industry and the third sector to support you to achieve sustainable improvement to cardiovascular disease care and prevention. Together, we will assess the impact of the pandemic on cardiac and stroke services, examine innovations and adaptations that have worked well and learn how to take these innovations forward to improve prevention and care in the long term. Registration
  8. News Article
    A leading health expert has suggested ministers have “lost control of the virus”, after the UK recorded it’s largest 24-hour spike in COVID-19 cases since 23 May. Government figures showed there have been a further 2,988 lab-confirmed cases of coronavirus in the UK as of 9am on Sunday. This brings the total number of confirmed cases in the UK to 347,152. Sunday's figure is the highest since May 22 when 3,287 cases were recorded, and is also the first 24-hour period when cases passed 2,000 since the end of May. The tally was an increase on Saturday's figures of 1,813 new cases. Prof Gabriel Scally, a member of the Independent Sage group and a former NHS regional director of public health for the south-west, warned that government ministers had “lost control of the virus”. “It’s no longer small outbreaks they can stamp on,” he told The Guardian. “It’s become endemic in our poorest communities and this is the result. Shadow health secretary Jonathan Ashworth called upon the government to respond to the sharp spike. He added that it was “a stark reminder that there is no room for complacency in tackling the spread of the virus”. “This increase, combined with the ongoing testing fiasco where ill people are told to drive for miles for tests, and the poor performance of the contact tracing system, needs an explanation from ministers,” he said on Sunday. Read full story Source: The Independent, 7 September 2020
  9. News Article
    Inquest finds Susan Warby, 57, received insulin she did not need after blood test mistakes. Hospital errors contributed to her death five weeks after bowel surgery, an inquest into her death has concluded. Susan Warby, 57, who died at West Suffolk hospital in Bury St Edmunds, was incorrectly given glucose instead of saline through an arterial line that remained in place for 36 hours and resulted in inaccurate blood test readings. She was subsequently given insulin she did not need, causing bouts of extremely low blood sugar (hypoglycemia) and the development of “a brain injury of uncertain severity”, recorded Suffolk’s senior coroner, Nigel Parsley. Speaking after the inquest was adjourned in January, Susan's husband, Jon Warby, said he was “knocked sideways completely” when he received an anonymous letter two months after her death highlighting blunders in her treatment. Doctors at the hospital were reportedly asked for fingerprints as part of the hospital’s investigation into the letter, a move described by a Unison trade union official as a “witch-hunt” designed to identify the whistleblower. Following January’s adjournment, Parsley instructed an independent expert to review the care that Warby received. Warby’s medical cause of death was recorded as multi-organ failure, with contributory causes including septicaemia, pneumonia and perforated diverticular disease, affecting the bowel. Recording a narrative conclusion, Parsley wrote: “Susan Warby died as the result of the progression of a naturally occurring illness, contributed to by unnecessary insulin treatment caused by erroneous blood test results. This, in combination with her other comorbidities, reduced her physiological reserves to fight her naturally occurring illness.” Jon Warby said in a statement: “The past two years have been incredibly difficult since losing Sue, and it is still a real struggle to come to terms with her no longer being here. The inquest has been a highly distressing time for our family, having to relive how Sue died, but we are grateful that it is over and we now have some answers as to what happened." “After learning of the errors in Sue’s care, I wanted to know how these occurred and what action was being taken to prevent any similar incidents in the future. The trust has now made a number of changes which I am pleased about.” Read full story Source: The Guardian, 7 September 2020
  10. News Article
    Greater NHS support is needed for people chronically ill for months with COVID-19 symptoms, experts have told BBC Radio 4's File on 4. The Royal College of GPs is calling for a national network of "post-Covid" clinics to help such people. But less than 12% of 86 NHS care commissioning groups asked by the BBC said they were running such services. NHS England said it was "rapidly expanding new and strengthened rehab centres". Tim Spector, professor of genetic epidemiology at King's College London and leader of the Covid Symptom Study app, said around 300,000 people in the UK have reported symptoms lasting for more than a month - so called "long Covid". He added that data from the app showed around 60,000 people have been ill for more than three months. However, many of these people may not have been tested for Covid. The government moved away from community testing on 12 March, instead only testing those admitted to hospital. That meant people who recovered from suspected coronavirus at home were unable to access tests. Elly MacDonald, 37, from Surbiton, was training for the London Marathon when she first developed what she believes were Covid symptoms on 21 March. More than five months on, she still suffers from breathlessness and extreme fatigue, but has not received a positive test result - because community testing was re-introduced too late for it to detect her illness. She changed her GP practice after initially feeling she was not being helped. Elly said: "Just knowing that I actually have people who are taking me seriously - that's been very important for my recovery. I just want my life back." Read full story Source: BBC News, 8 September 2020
  11. News Article
    In April, when the coronavirus outbreak was at its peak in the UK and tearing through hospitals, junior doctor Rebecca Thornton’s mental health took a turn for the worse and she ended up having to be sectioned. Even now, three months later, she cannot face going back to her job and thinks it will take her a year to recover from some of the horrors she saw while working on a Covid ward in a deprived area of London. “It was horrendous,” Thornton recalls. “It’s so harrowing to watch people die, day in, day out. Every time someone passed away, I’d say, ‘This is my fault’. Eventually I stopped eating and sleeping.” Thornton’s case may sound extreme but her experiences of working through Covid are far from unique. More than 1,000 doctors plan to quit the NHS over the government’s handling of the pandemic, according to a recent survey, with some citing burnout as a cause. A psychologist offering services to NHS staff throughout the UK, who asked to remain anonymous, has witnessed the toll on staff. “I’ve seen signs of PTSD in some healthcare workers,” she says. “Staff really stood up to the plate and worked incredibly hard. It was a crisis situation that moved very quickly ... After it subsided a little bit, the tiredness became very clear.” Roisin Fitzsimons, who is head of the Nightingale Academy, which provides a platform to share best practice in nursing and midwifery, and consultant nurse at Guy’s and St Thomas’ NHS foundation trust, also worries about the looming threat of an uncertain future. “Are our staff prepared? Do they have the resilience to go through this again? That’s the worry and that’s the unknown. Burnout is hitting people now. People are processing and realising what they’ve gone through.” Read full story Source: The Guardian, 8 September 2020
  12. News Article
    COVID-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists in Hong Kong showed. The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said. SARS-CoV-2 spreads mainly through respiratory droplets -- spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists in China have said infectious virus in the stool of patients may also play a role in transmission. The finding “highlights the importance of long-term coronavirus and health surveillance and the threat of potential fecal-oral viral transmissions,” Siew Chien Ng, associate director of the university’s Centre for Gut Microbiota Research, said in the statement. Read full story Source: Bloomberg, 7 September 2020
  13. Event
    This year’s programme brings together highly ranked representatives of international and national healthcare authorities, NGOs, policymakers, clinical scientists, researchers, and pioneers in healthcare improvement with the unified goal of improving AMR and sepsis healthcare around the world. The objectives of this free Spotlight online congress are to review achievements, challenges, and potential solutions to combat the threats posed by AMR and sepsis globally. Speakers will describe the current global epidemiology and burden of sepsis and AMR, explore a future research agenda, provide an overview of lessons and challenges from the COVID-19 pandemic and recent Ebola outbreaks, and ultimately explore innovative and cost-effective approaches to preventing and combating sepsis and AMR. The WSC Spotlight is a free online congress and is attended by a large number of clinicians, health decision-makers, and other health workers. For example, more than 40,000 people from 160 countries tuned in to the 2017 WSC Spotlight on maternal and neonatal sepsis (and accessed more than 300,000 times on YouTube and Apple Podcasts in the following weeks). Moreover, at the occasion of this congress, WHO will launch the first Global report on the epidemiology and burden of sepsis. The report describes results from original research and existing published evidence, the methodologies and limitations of the studies, and identifies gaps and priorities for future research. Programme and registration
  14. News Article
    Over 1,000 doctors plan to quit the NHS because they are disillusioned with the government’s handling of the COVID-19 pandemic and frustrated about their pay, a new survey has found. The doctors either intend to move abroad, take a career break, switch to private hospitals or resign to work as locums instead, amid growing concern about mental health and stress levels in the profession. “NHS doctors have come out of this pandemic battered, bruised and burned out”, said Dr Samantha Batt-Rawden, president of the Doctors’ Association UK, which undertook the research. The large number of medics who say they will leave the NHS within three years is “a shocking indictment of the government’s failure to value our nation’s doctors,” she added. “These are dedicated professionals who have put their lives on the line time and time again to keep patients in the NHS safe, and we could be about to lose them.
  15. News Article
    A leaked government report suggests a "reasonable worst case scenario" of 85,000 deaths across the UK this winter due to COVID-19. The document also says while more restrictions could be re-introduced, schools would likely remain open. But it says the report "is a scenario, not a prediction" and the data are subject to "significant uncertainty". However some are critical of the modelling and say some of it is already out of date. The document, which has been seen by BBC Newsnight, was prepared for the government by the Sage scientific advisory group, which aims to help the NHS and local authorities plan services, such as mortuaries and burial services, for the winter months ahead. Read full story Source: BBC News, 29 August 2020
  16. Content Article
    Human factors is a critical component of future aviation success in both military and civil aviation systems, especially where it concerns safety. This white paper from the Chartered Institute of Ergonomics and Human Factors contains the visions of 15 ‘thought leaders’, showing how they believe aviation evolution will unfold between now and 2050, and the critical role of human factors in ensuring system performance and safety. The thoughts in this paper can be applied to human factors in health and social care.
  17. Content Article
    Informed consent is a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made: Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; With adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention. Ensuring informed consent is properly obtained is a legal, ethical and professional requirement on the part of all treating health professionals and supports person-centred care. Good clinical practice involves ensuring that informed consent is validly obtained and appropriately timed. This fact sheet from the Australian Commission on Safety and Quality in Healthcare includes information for clinicians about informed consent in healthcare. 
  18. Content Article
    The Healthcare Safety Investigation Branch (HSIB) has published their third annual review. During 2019/20: 109 patient safety referrals received. 515 maternity investigation reports completed. 15 national investigation reports published. 58 national safety recommendations made. 88% of families engaging with the maternity investigations and 87% with the national investigations. Family information available in over 20 languages to ensure greater inclusivity. Keith Conradi, Chief Investigator, said: “There has been a huge amount of hard work from everyone within the HSIB during this period and I want to thank them and acknowledge the support of our stakeholders in the wider healthcare sector, and in particular to all the organisations who responded promptly to our safety recommendations.”
  19. Content Article
    There is increasing interest and belief in applying quality improvement (QI) to help solve our most complex challenges in healthcare, yet little published literature to help leaders develop a business case and evaluate return on investment from QI. This is even more pronounced in fields such as mental health and community health services. This paper from Amar Shah and Steven Course presents a framework to help identify, understand and evaluate return on investment from large-scale application of QI in healthcare providers. The framework has been developed at East London NHS Foundation Trust (ELFT), a provider of predominantly mental health and community health services to a population of 1.5 million people, which has been undertaking QI at scale since 2014. This paper presents case studies and examples from ELFT to illustrate return on investment from QI at multiple levels: improving outcomes for patients and service users, improving the experience of staff, improving productivity and efficiency, avoiding costs, reducing costs and increasing revenue.
  20. News Article
    A survey of members of the Royal College of Physicians (RCP) has found that almost two thirds (60%) of doctors worry that patients in their care have suffered harm or complications following diagnosis or treatment delays during the pandemic, while almost all doctors (94%) are concerned about the general indirect impact of COVID-19 on their patients. This is also compounded by the difficulty doctors are finding in accessing diagnostic testing for their patients. Only 29% of doctors report experiencing no delays in accessing endoscopy testing (one of the main diagnostic tests used by doctors) for inpatients, decreasing to just 8% for outpatients. Only 5% of doctors feel that their organisations are fully prepared for a potential second wave of COVID-19 infection, and almost two thirds (64%) say they haven’t been involved in any discussions about preparations for a second wave of the virus. While the government’s promise to roll out flu vaccines to millions more people is welcome, the RCP recently set several more priorities to help prepare the health service for future waves of COVID-19, including the need to ensure the NHS estate is fully able to cope. Only 5% say they wanted an antibody test for COVID-19 but were unable to access one. Of those tested, a quarter (25%) were positive, with little or no difference when it came to gender, between white and BAME doctors, trainees and consultants or between London and the rest of England. Professor Andrew Goddard, president of the Royal College of Physicians, said: “Delays to treatment are so often a major issue for the NHS but as a result of the COVID-19 pandemic, it’s fair to say we’ve reached crisis point. Doctors are, understandably, gravely concerned that their patients’ health will have deteriorated to the point where they will need much more extensive treatment than previously, at a time when NHS resources are already incredibly depleted." “We also cannot underestimate the need to prepare for a second wave of COVID-19 infection, which threatens to compound the situation. Without careful and rigorous preparation, a second wave coupled with the winter flu season, could overwhelm the NHS.” Source: Royal College of Physicians, 5 August 2020
  21. Content Article
    For physicians, the words “I can’t breathe” are a primal cry for help. As many physicians have left their comfort zones to care for patients with COVID-19–associated respiratory failure, the role of the medical profession in addressing this life-defining need has rarely been clearer. But as George Floyd’s repeated cry of “I can’t breathe” while he was being murdered by a Minneapolis police officer has resounded through the country, the physician’s role has seemed less clear. Police brutality against black people, and the systemic racism of which it is but one lethal manifestation, is a festering public health crisis. Can the medical profession use the tools in its armamentarium to address this deep-rooted disease? Evans et al. explore this further in an Editorial in the New England Journal of Medicine.
  22. News Article
    There has been a sharp rise in the number of nurses considering quitting the profession compared to this time last year, suggest results from a new survey. The research also found that “existing tensions” among the workforce appeared to have been “exacerbated” by the COVID-19 crisis. The survey findings feature in a new report published by Royal College of Nursing and cover the views of almost 42,000 of its members across the UK and Channel Islands. Of those who responded to the survey, 36% of nurses were thinking of leaving the profession, an increase from 27% reported in a similar piece of research carried out at the end of last year. When considering the reasons for quitting, 61% of staff indicated that the level of pay was the “main driver”, while others said they were dissatisfied with the way nursing staff had been treated during the pandemic (44%). Meanwhile, 43% of nurses cited low staffing levels and 42% a lack of management support as key reasons for wanting to leave nursing. Read full story Source: Nursing Times, 17 July 2020
  23. News Article
    British scientists analysing data from a widely-used COVID-19 symptom-tracking app have found there are six distinct types of the disease, each distinguished by a cluster of symptoms. King’s College London team found that the six types also correlated with levels of severity of infection, and with the likelihood of a patient needing help with breathing - such as oxygen or ventilator treatment - if they are hospitalised. The findings could help doctors to predict which COVID-19 patients are most at risk and likely to need hospital care in future waves of the epidemic. Read full story Source: Reuters, 17 July 2020
  24. Content Article
    During the COVID-19 pandemic, health care leaders are working to support staff who are experiencing anxiety, stress, and intense demands. This guide from the Institute of Healthcare Improvement (IHI), which builds on the IHI Framework for Improving Joy in Work, includes actionable ideas that leaders can quickly test during the coronavirus response, and which can build the longer-term foundation to sustain joy in work for the health care workforce.
  25. News Article
    A GP surgery that had been told it required improvement has been shut down after an inspection found patients could be at "risk of harm". Hampshire's Brockhurst Medical Centre had already been due to close on 31 December. However, the Care Quality Commission (CQC) suspended its registration with "immediate effect" following an unannounced inspection on Monday. Patients are expected to be transferred to other practices on Saturday. In September, a CQC assessment of the practice, on Brockhurst Road in Gosport, rated it overall as "requires improvement". The issues highlighted in the report included that the practice "did not have systems for the appropriate and safe use of medicines" and "there was a risk that some patients were not receiving the care and treatment they needed". Following Monday's inspection, Garry Higgins, of the CQC, said it had taken "urgent action" to suspend the registration of the GP surgery. "We took the action because we believe if we didn't people using the service may be exposed to the risk of harm," he added. Read full story Source: BBC News, 5 December 2020
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