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Content ArticleThe aim of community diagnostic centres (CDCs) is to deliver additional diagnostic capacity in England by providing quicker and more convenient access for patients and reducing pressure on hospitals. The vision is for CDCs to be ‘one-stop shops for checks, scans and tests’, designed to achieve early diagnoses for patients and timely treatment and intervention, and are part of the offer of more place-based, person-centred approaches to care, removing some of the known barriers to access. But are CDCs living up to their promise?
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Content Article
Pancreatic Cancer UK: Real life stories section
Patient Safety Learning posted an article in Patient stories
These stories provide examples of how people with pancreatic cancer are diagnosed, the treatment they have, their experiences and how they take care of themselves. Everyone diagnosed with pancreatic cancer will be different in terms of how they received their diagnosis and how they respond to and cope with treatment. -
Content ArticleThis short video talks about the importance of recognising the signs and symptoms of head and neck cancer at the earliest opportunity, and describes actions which can be taken to support earlier diagnosis. Although aimed at pharmacists, it provides useful information for all patients and healthcare professionals on symptoms that might indicate head and neck cancer.
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News Article
Influx of very low risk referrals sparks review of cancer services
Patient Safety Learning posted a news article in News
NHS England is in talks about changing a pathway for women with breast problems after performance against the two-week target for them to be seen plummeted. HSJ understands discussions are ongoing between NHS England and the Association of Breast Surgery about changing the symptomatic breast pathway for some patients. This has been prompted by concerns that one stop breast clinics – which take those referred both via the symptomatic route and the standard two-week pathway for suspected cancer – are being flooded with very low risk patients, potentially meaning those at higher risk of cancer wait longer for tests and diagnosis. The symptomatic pathway, which is for patients where cancer is not initially suspected by their GP, was introduced in 2010 because only about half of diagnosed breast cancers were being referred on the normal two-week pathway. The national target is for 93% of patients to be seen within two weeks. However, since 2018-19, national performance against this has reduced from 85.8% to 64.1% last year. There are concerns the pathway has led to too many patients being referred for diagnostic procedures which are inappropriate for their symptoms, preventing those who are more in need of such tests from accessing them in a timely manner. Association of Breast Surgery president Chris Holcombe said: “GPs tend to be quite cautious and send most people along even if the risk is quite small. We will get patients who are 25 and, to be honest, before they come to clinic, I could tell you with 99 per cent certainty they won’t have cancer. But they are worried as anything.” Alternatives to the symptomatic breast pathway which could reduce pressure on one stop clinics and also offer patients a better service are now being evaluated, he said. “There are appropriate ways to see these patients other than in a very high resource clinic,” he added. “But they still need to be seen and seen quickly otherwise they will just bounce back into the one stop clinic.” Read full story (paywalled) Source: HSJ, 10 October 2022 -
Content ArticleCommunity Diagnostic Centres (CDCs) can relieve pressure on NHS acute services and bring diagnostic services closer to patients. This resource by the Chartered Institute of Ergonomics & Human Factors (CIEHF) explores ten principles for including systems thinking in the design of the diagnostic workforce and CDC services.
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Content Article
Risk of suicide after dementia diagnosis (3 October 2022)
Patient Safety Learning posted an article in Dementia
Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services. In this study, Alothman et al. examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups. They found that dementia was associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities. Given the current efforts to improve rates of dementia diagnosis, these findings emphasise the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups. -
News Article
England skin and breast cancer patients have worst waiting time to see specialist
Patient Safety Learning posted a news article in News
Patients with suspected skin and breast cancer have experienced the largest increase in waiting times of everyone urgently referred to a cancer specialist, with 1 in 20 patients now facing the longest waits, analysis of NHS England data shows. Almost 10,000 patients referred by a GP to a cancer specialist had to wait for more than 28 days in July – double the supposed maximum 14-day waiting time. Three-quarters of them were suspected of having skin, breast or lower gastrointestinal cancer, a Guardian analysis has revealed. In total, 53,000 people in England waited more than two weeks to see a cancer specialist. That is 22% of all the patients urgently referred for a cancer appointment by their GPs. Minesh Patel, head of policy at Macmillan Cancer Support, said people were waiting “far too long for diagnosis or vital treatment”. Patients “are worried about the impact of these delays on their prognosis and quality of care”. “The NHS has never worked harder,” said Matt Sample, the policy manager at Cancer Research UK, but patients dealing with long waits “reflects a broader picture of some of the worst waits for tests and treatments on record”. “When just a matter of weeks can be enough for some cancers to progress, this is unacceptable.” Read full story Source: The Guardian, 2 October 2022 -
Content ArticleAt the start of the Covid-19 pandemic, demand on the NHS 111 system exceeded capacity and only around half of calls were answered during that time. This investigation by the Healthcare Safety Investigation Branch (HSIB) aimed to support improvements in the delivery of NHS 111 and other telephone triage services during a national healthcare emergency. HSIB first identified a potential safety risk associated with NHS 111’s response to callers with Covid-19-related symptoms when concerns were raised through HSIB’s Citizens’ Partnership. The national investigation aimed to understand: the set-up, design and delivery of the Covid-19 telephone triage service accessed by the public by dialling 111 in response to the pandemic. the context and contributory factors influencing the pathway for patients calling NHS 111 with Covid-19-related symptoms. The investigation used four real patient safety incidents involving patients and their families who dialled NHS 111 for advice during the Covid-19 pandemic. All four patients in these reference events—Vincenzo, Ali, Patrick and Dr C—died of Covid-19 having been advised by NHS 111 to stay at home.
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News Article
Dying patient should have been seen in person
Patient Safety Learning posted a news article in News
NHS officials ruled a man who died after his ear infection was not picked up in GP telephone consultations should have been seen face to face, a BBC Newsnight investigation has found. David Nash, 26, had four remote consultations over three weeks during Covid restrictions but was never offered an in-person appointment. His infection led to a fatal abscess on his brainstem. David first spoke to the practice on 14 October 2020, after finding lumps on his neck. He sent a photograph but was never examined. With David worried the lumps might be cancerous, the GP asked a series of questions about his health and reassured him that while she could not rule it out completely, she was not worried about cancer. She suggested he booked a blood test for two to three weeks' time. In those three weeks, David would go on to speak to another GP and two advanced nurse practitioners but never face to face or via video call. He was actually due to be seen in person at the GP surgery that day, for the blood tests booked some 19 days earlier, when he had presented with neck lumps. But - fearing he could have coronavirus, despite a negative PCR test - the nurse cancelled the bloods and asked David to retest for Covid. In its investigation, NHS England found "the overarching benefit [of this decision] was less than the risk with going ahead with blood tests". After five calls to NHS 111, David was taken to hospital in an ambulance that day but died two days later. NHS England, in a finding seen by Newsnight, said: "A face-to-face assessment should have been offered or organised to confirm the diagnosis and initiate definitive management." Read full story Source: BBC News, 29 September 2022 -
News Article
Women's symptoms ignored by GPs
Patient Safety Learning posted a news article in News
Too many women feel fobbed off or not listened to when they raise concerns about their health, according to a women's health campaign group. The Women's Health Wales coalition says women are often misdiagnosed or have to push for a diagnosis. The theme has emerged repeatedly during BBC Wales interviews with women. The Welsh government said it had set out what's expected of the NHS on women's health, and a full plan is due to be published this autumn. "From the moment I went to my GP about my symptoms in my late teens, I have always felt dismissed," said Jessica Ricketts, 35, who was diagnosed with endometriosis. But the feeling of being fobbed off has cropped up in countless conversations with women whether it be in relation to a heart attack, UTI, stroke, autism or even brain tumour. Patients have told us that clinicians thought they were having a panic attack rather than a heart attack," said Gemma Roberts, policy and public affairs manager at British Heart Foundation Cymru, and co-chair of the Women's Health Wales coalition. "We hear from patients and from clinicians that women have to see their GPs multiple times before they get a diagnosis. Women often aren't listened to. "They are told that pain is a normal part of the female experience but actually that isn't the case. I think we need to be listening to women more about what's going on with their own bodies." The coalition wants: Greater focus on women's health from the very beginning of medical training. Health data to be broken down by protected characteristics because "the stories of women with those backgrounds goes untold". Equitable access to healthcare, including specialist care, regardless of where women live in Wales. Read full story Source: BBC News, 28 September 2022 Related blogs on the hub ‘Women are being dismissed, disbelieved and shut out’ The normalisation of women’s pain Gender bias: A threat to women’s health -
Content ArticleAn estimated 1 in every 182 Americans will be diagnosed with cancer this year. Providing them safe care has inherent challenges, such as reaching an accurate diagnosis as quickly as possible, differentiating between disease progression and treatment side effects, and addressing broader systemic risks. Caitlyn Allen, sat down with medical oncologist and former chief quality officer of the Dana-Farber Cancer Institute, Dr. Joseph O. Jacobson, to discuss the evolution of oncology care and what the future may hold.
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Content Article70,000 people in the UK are living with pulmonary fibrosis. Action for Pulmonary Fibrosis has the information, support and stories to help you live a healthier life with pulmonary fibrosis.
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Content Article“I wish my GP had known more about my disease” is a comment made by patients with pulmonary fibrosis and idiopathic pulmonary fibrosis on a regular basis. Pulmonary fibrosis can be difficult to diagnose and misdiagnosis is common. That’s why Action for Pulmonary Fibrosis has partnered with the Royal College of General Practitioners to create a new module aimed at improving awareness of pulmonary fibrosis diagnosis. They have also got resources and materials for your patient, so that they have the support they need from diagnosis.
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Content ArticleFor people who have been diagnosed with dementia, accessing post-diagnosis support can be challenging, particularly when the systems meant to provide support are confusing, limited or in some areas, non-existent. The World Alzheimer Report 2022 looks at the issues surrounding post-diagnosis support, a term that refers to the variety of official and informal services and information aimed at promoting the wellbeing of people with dementia and their carers. This report explores the aspects of living with dementia following diagnosis, through 119 essays written by researchers, healthcare professionals, informal carers and people living with dementia from around the world. These expert essays are accompanied by the results of a survey carried out in May 2022, with responses from 1,669 informal carers in 68 countries, 893 professional carers in 69 countries and 365 people with dementia from 41 countries.
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Content ArticleThis video series by the Australian Commission on Safety and Quality in Healthcare aims to promote sepsis awareness among healthcare professionals and the wider community. The three videos were created as part of the Australian National Sepsis Awareness Campaign. The videos provide key information about: sepsis signs and symptoms. potential health problems after sepsis. simple ways to reduce the risk of sepsis. timely recognition and management of sepsis across healthcare settings.
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News ArticleHardeep Singh, an informatics leader, patient safety advocate and innovator, and friend of the Jewish Healthcare Foundation (JHF), has been awarded the Individual Achievement Award in the 20th John M. Eisenberg Patient Safety and Quality Awards for demonstrating exceptional leadership and scholarship in patient safety and healthcare quality through his substantive lifetime body of work. The Joint Commission and National Quality Forum present Eisenberg Awards annually to recognise major achievements to improve patient safety and healthcare quality. Dr Singh, chief of the Health Policy, Quality & Informatics Program in the Center for Innovations in Quality, Effectiveness and Safety at Michael E. DeBakey VA Medical Center and professor at Baylor College of Medicine, was recognised for his pioneering career in diagnostic and health IT safety and his commitment to translating his research into pragmatic tools, strategies, and innovations for improving patient safety. His commitment to improving patient safety began while pursuing his Master of Public Health at the Medical College of Wisconsin in 2002 when he first learned the field of patient safety existed. That commitment was galvanised early in his medical career, as he found himself treating patients who had been misdiagnosed, received unsafe care, or experienced poor outcomes. The breadth and depth of Dr Singh's research work is remarkable, but what is most notable is the extent to which he has succeeded in translating it into pragmatic strategies and innovations for improving patient safety. Dr. Singh emphasised that while the Eisenberg Award recognizes an individual for their achievements, his work in patient safety has been successful because of its multi-disciplinary and collaborative approach with psychologists, human factors engineers, social scientists, informaticians, patients, and more. That work has led to the development of several tools to improve patient safety, including The Safer Dx Checklist, which helps organizations perform proactive self-assessment on where they stand in terms of diagnostic safety. "As an immigrant and an international medical graduate, I have had a lifelong dream to make an impact on health care. I saw every scientific project as an opportunity to change health care. So, I made a personal commitment that my research must use a pragmatic, real-world improvement lens and challenge the status quo in quality and safety," Dr. Singh said. Read full story Source: Jewish Healthcare Foundation News, 31 August 2022
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News ArticleAt least 12,000 people were treated for sepsis in hospitals in Ireland last year, with one in five of those dying from the life-threatening condition. However, the HSE said the total number of cases is likely to be much higher. Marking World Sepsis Day, it said the condition kills more people each year than heart attacks, stroke or almost any cancer. The illness usually starts as a simple infection which leads to an “abnormal immune response” that can “overwhelm the patient and impair or destroy the function of any of the organs in the body”. Dr Michael O’Dwyer, the HSE’s sepsis clinical lead, said: “The most effective way to reduce deaths from sepsis is by prevention. “A healthy lifestyle with moderate exercise, good personal hygiene, good sanitation, breastfeeding when possible, avoiding unnecessary antibiotics and being vaccinated for preventable infections all play a role in preventing sepsis. “Early recognition and then seeking prompt treatment is key to survival. Recognising sepsis is notoriously difficult and the condition can progress rapidly over hours or sometimes evolve slowly over days.” Read full story Source: Independent Ireland, 13 September 2022 hub resources on sepsis RCNi: Sepsis resource collection NSW Clinical Excellence Commission - Sepsis toolkit Dr Ron Daniels video: Recognising sepsis Introducing the Suspicion of Sepsis Insights Dashboard
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Content ArticleIn this blog for Psychology Today, Gary Klein looks at the psychological causes of diagnostic errors, arguing that being clear about the exact causes of these errors is the only way to reduce them. Drawing on physical causes of diagnostic error identified in an Institute of Medicine report in 2015, he highlights the need to go further in understanding the explanations the report offers for diagnostic errors.
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News Article
Excess deaths continue to soar despite Covid deaths decreasing
Patient Safety Learning posted a news article in News
Excess deaths in the UK have continued to soar, as Covid deaths decreased for fourth week in a row, the latest data shows. A total of 10,942 deaths from all causes were registered in England and Wales in the week to 26 August, according to the Office for National Statistics. This is 16.6%above the five-year average, the equivalent of 1,556 “excess deaths” during this week. However, new figures show a continued downward trend in deaths involving Covid-19, which have fallen to the lowest level since the beginning of July. A total of 453 deaths registered in the seven days to August 26 mentioned coronavirus on the death certificate, according to the Office for National Statistics (ONS) – down 18 per cent on the previous week. Stuart Macdonald, from the Covid-19 actuaries’ response group, wrote: “There have been around 5,300 deaths with Covid-19 mentioned on the death certificate in the last ten weeks. Covid was the underlying cause for 3,400 of these and may also have contributed to others. Since Covid does not explain all the recent excess we need to look at other causes.” Mr Macdonald outlined a number of potential drivers of excess deaths which included increased risk of heart failure in people following Covid-19 infection, delays for urgent treatment within the NHS and missed or delayed diagnoses earlier in the pandemic. Read full story Source: The Independent, 6 September 2022 -
Content ArticleIn order to become competent clinicians, doctors need to appropriately calibrate their clinical reasoning, but lack of follow-up after transitions of care can present a barrier to this. This study in the Journal of Hospital Medicine aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. The authors concluded that structured feedback for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.
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Content ArticleTo improve their diagnosis and management skills, doctors need consistent, timely and accurate feedback, as it helps them become better calibrated, leading to more appropriate clinical decisions. Despite its benefits, clinicians do not consistently receive information on the subsequent clinical outcomes of patients they have diagnosed and treated, known as patient outcome feedback. This paper discusses challenges faced in developing systems for effective patient outcome feedback. The authors propose applying a sociotechnical approach using health IT to support these systems. The concepts they discuss are applicable not only to fragmented systems of care, but also to integrated health systems that plan to harness the benefits of integration for providing effective clinician feedback.
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Content ArticleReducing errors in diagnosis is the next big challenge for patient safety. This article highlights ways in which healthcare organisations can pursue learning and exploration of diagnostic excellence (LEDE). Building on current evidence and their recent experiences in developing such a learning organisation at Geisinger in Pennsylvania, the authors propose a 5-point action plan and corresponding policy levers to support the development of LEDE organisations.
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Content ArticleThis infographic accompanies the TeamSTEPPS for diagnosis improvement course from the US Agency for Healthcare Research and Quality (AHRQ).
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Content Article
AHRQ course- TeamSTEPPS® for diagnosis improvement
Patient-Safety-Learning posted an article in Diagnosis
Diagnostic harm is an area of concern in healthcare quality and patient safety. A growing body of patient safety and care delivery research shows that diagnostic harm is both widespread and costly. TeamSTEPPS is an evidence-based program built on a framework composed of four teachable, learnable skills—communication, leadership, situation monitoring and mutual support. The TeamSTEPPS for Diagnosis Improvement Course applies the TeamSTEPPS framework to the specific problem of diagnostic error. On the course. teams will learn about how improved communication among all members of the team can help lead to safer, more accurate and more timely diagnosis in all healthcare settings. The course can be delivered virtually, in a classroom setting or as individual self-paced learning modules. Additional resources for trainees include: Team assessment tool for improving diagnosis Case study of the diagnostic journey of Mr. Kane Reflective practice tool Postcourse knowledge assessment -
Content ArticleBabylon is a US company that offers AI-powered online apps to health systems. Several UK hospital trusts have used Babylon apps to triage patients and reduce attendances at accident and emergency departments since 2018. In this blog, Nicole Kobie, contributing editor at technology website Wired, looks at Babylon's recent cancellation of its last contract with an NHS trust. She highlights that although some welcome Babylon's exit from the NHS, the disruption caused by the apps' implementation was costly and has left some trusts with large bills. The apps also triggered complaints from the Medicines and Healthcare products Regulatory Agency (MHRA) after concerns that Babylon's AI was missing signs of serious illness. The article highlights the need to carefully consider patient safety and cost-effectiveness when introducing new technologies into health systems, and take a slower approach to rolling out AI innovations.
