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Found 421 results
  1. News Article
    An emergency unit at a Norwich hospital has reduced ward admissions and is helping shield urgent non-COVID-19 patients. The older people’s emergency department (Oped) – a special unit at the Norfolk and Norwich university hospital – is providing emergency care for patients over 80. Launched in 2017, the unit, just down the corridor from A&E, has six beds, two in side rooms and no waiting room. Normally, it admits patients identified as frail and usually with multiple conditions that need a lot of care (such as cognitive impairment, incontinence or reduced mobility). They are brought straight in by ambulance or trolley from other parts of the hospital and seen by a consultant geriatrician within two hours. A team of nurses with experience in both emergency care and care of the elderly, pharmacists and physiotherapists are on hand to support patients much more quickly than A&E to get patients out of hospital and back home within the same day wherever possible. For patients who need to stay longer after treatment there is an adjacent ambulatory ward. This unique model is showing results. The proportion of the specialist department’s patients admitted to the hospital is 50% compared with 68% for the same age group of emergency patients coming to the hospital five years ago, when they were treated at the normal A&E. When Oped patients are admitted, their average length of stay is 1.2 days less. “It’s just what we want for old people,” says Dr Sarah Bailey, the department’s lead consultant geriatrician. “We get the experts in straight away because we recognised that’s the best thing for [them]”. During the pandemic, the unit is helping to keep those who do not have coronavirus symptoms, such as those with injuries from falls and some stroke patients, away from the main A&E ward, providing a degree of shielding not normally possible. But for most NHS trusts, providing a separate unit like Oped is not feasible. “Hospitals are working to separate emergency patients with respiratory problems from those with other conditions,” says Dr Jay Banerjee, who leads the Royal College of Emergency Medicine’s work on emergency care for the elderly. “But most just do not have the capacity to also try to separate elderly patients with other conditions from younger patients.” Read full story Source: The Guardian, 27 May 2020
  2. News Article
    Weston General Hospital has stopped admitting new patients – including to the accident and emergency department – following a spike in coronavirus cases. The hospital announced yesterday it was taking this “precautionary measure” due to the “high number of coronavirus patients” on site. MP for Weston-super-Mare John Penrose tweeted that he had spoken to local health chiefs and a deep clean is being carried out at the hospital “following a spike in infections”. He added that a temporary A&E has been set up outside the hospital, while inpatients will be re-directed to hospitals in Taunton or Bristol. Out of hours GP practices, pharmacies and walk-in services at the minor treatment unit in Clevedon and Yate have also been given as alternative options for patients seeking medical treatment. Read full story Source: HSJ, 25 May 2020
  3. News Article
    A hospital A&E department has been rated "inadequate" after inspectors found patients at "high risk of avoidable harm". The Care Quality Commission (CQC) reported a "range of regulation breaches" and a shortage of nurses at Stepping Hill hospital's A&E unit. It also criticised maternity and children's services. Stockport NHS Foundation Trust's chief executive said the trust had taken "immediate steps" to improve. The CQC inspected Stepping Hill Hospital in January and February and found A&E performance "had deteriorated significantly" since its last inspection in 2018. Inspectors found shortcomings "relating to patient-centred care, dignity and respect, safe care and treatment, environment and equipment, good governance, and staffing". Their report said the service "could not assure itself that staff were competent for their roles" and patient outcomes "were not always positive or met expectations in line with national standards". Read full story Source: BBC News, 19 May 2020
  4. News Article
    A&E admissions in the UK have fallen to the lowest on record, with a 57% year-on-year drop in attendances in England, new NHS data shows. The latest figures show a dramatic fall in demand for emergency treatment, falling below one million attendances per month for the first time since records began in 2010. The coronavirus crisis has placed additional strain on NHS resources, but is thought to have had the opposite effect on A&E, with the public staying at home and avoiding hospitals where possible. Read full story (paywalled) Source: The Telegraph, 14 May 2020
  5. News Article
    "I have never seen my A&E department so still, so well-staffed and so uncannily calm," says Steven Fabes, an A&E doctor. Attendances in A&E departments across the country are down, in some cases by up to 80%. There is an obvious reason for the calm: people are not out and about. Pedestrians are not walking out in front of cyclists. Cyclists are not diving over car bonnets. Asthmatics are not wheezing through the fumes of Oxford Street. But there is something more worrying at play, too – people who need us are not coming in. "I am worried that people who need us are not coming in, scared that hospitals are vectors for infection rather than cure," says Steven. Read full story Source: The Guardian, 23 April 2020
  6. News Article
    The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden. “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.” Read full story Source: The Guardian, 16 April 2020
  7. News Article
    Medical leaders have warned sick patients not to avoid getting help from the NHS after a huge drop in the numbers of people attending A&E departments sparked fears some could die without care. In March, the number of people going to their local emergency department fell by 600,000, or 29 per cent, compared to same month last year, the lowest number of attendances since 2010. While the NHS has battled for years to reduce the number of people going to A&E for unnecessary reasons, the sudden fall during the coronavirus epidemic has worried officials that the pandemic could be deterring people who have genuine need and who could become sicker or even die as a result of staying away. Read full story Source: HSJ, 9 April 2020
  8. News Article
    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
  9. News Article
    Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said. Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation". One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency. The Welsh NHS Confederation said staff were "committed to the highest standards of care". In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents. Read full story Source: BBC News, 10 March
  10. News Article
    A&E units are so overcrowded that growing numbers of patients have to be looked after in hospital corridors, warn nurses and doctors. There are rising concerns that the “shameful” trend means people stuck in corridors are not getting the care they need, or they may be even coming to harm. A&E health professionals say “corridor nursing” is becoming increasingly widespread as emergency departments become too full to look after the sheer number of people seeking treatment. In a survey of 1,174 A&E nurses in the Royal College of Nursing’s (RCN) Emergency Care Association, 73% of those polled said they looked after patients in a “non-designated area” such as corridors every day and another 16% said they did so at least once a week, while 90% said they feared patient safety was being put at risk by those needing care having to spend time in areas of hospitals which did not have medical equipment or call bells. Staff have had difficulty administering urgent doses of intravenous antibiotics to such patients, some of whom have been denied privacy and found it harder to use a toilet or been left in distress, nurses said. Read full story Source: The Guardian, 26 February 2020
  11. News Article
    A double amputee suffered fatal pressure sores caused by "gross and obvious failings" in her hospital treatment. Janet Prince, from Nottingham, developed the sores after being admitted to Queen's Medical Centre (QMC) in July 2017. The 80-year-old died in January 2019. Assistant Coroner Gordon Clow issued a prevention of future deaths report to Nottingham University Hospitals NHS Trust (NUH). Nottingham Coroner's Court had heard Ms Prince was taken to QMC in Nottingham with internal bleeding on 15 July 2017. The patient was left on a trolley in the emergency department for nine hours and even though she and daughter Emma Thirlwall said she needed to be given a specialist mattress, she was not given one. "No specific measures of any kind were implemented during that period of more than nine hours to reduce the risk of pressure damage, even though it should have been easily apparent to those treating her that [she] needed such measures to be in place," Mr Clow said. Ms Prince was later transferred to different wards, but a specialist mattress was only provided for her a few days before she was discharged on 9 August, by which time Mr Clow said her wounds "had progressed to the most serious form of pressure ulcer (stage four) including a wound with exposed bone". Mr Clow said there were "serious failings" over finding an appropriate mattress and other aspects of her care while at the QMC, including "a gross failure" to prevent Ms Prince's open wounds coming into contact with faeces. Mr Clow said the immediate cause of her death was "severe pressure ulcers", with bronchopneumonia a contributory factor. Recording a death by "natural causes, contributed to by neglect", he said he was "troubled by the lack of evidence" of any changes to wound management at NUH. NUH medical director Keith Girling apologised for the failings in Ms Prince's care, claiming the trust had "learnt a number of significant lessons from this very tragic case". Read full story Source: BBC News, 14 February 2020
  12. News Article
    The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer-by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Last summer, the inquest into the London Bridge attack heard it took three hours for paramedics to reach some of the wounded. Prompt treatment might have saved the life of French chef Sebastian Belanger, who received CPR from members of the public and police officers for half an hour. A LAS debriefing revealed paramedics’ frustration at not being deployed sooner. A group of UK and international experts in delivering medical care during terrorist attacks have highlighted alternative approaches in the BMJ. In Paris in 2015, the integration of doctors with specialist police teams enabled about 100 wounded people in the Bataclan concert hall to be triaged and evacuated 30 minutes before the terrorists were killed. The experts writing in the BMJ believe the UK approach would have delayed any medical care reaching these victims for three hours. These are perilously hard judgment calls. Policymakers and commanders on the scene have to balance the likelihood that long delays in intervening will lead to more victims dying from their injuries against the increased risk to the lives of medical staff who are potentially putting themselves in the line of fire by entering the so-called 'hot zone'. First responders themselves need to be at the forefront of this debate. As the people who have the experience, face the risks and want more than anyone to save as many lives as possible, their leadership and insights are vital. In the wake of the Streatham attack the government is looking at everything from sentencing policy to deradicalisation. Deciding how best to save the wounded needs equal priority in the response to terrorism. Read full story Source: The Guardian, 7 February 2020
  13. News Article
    A&E waiting times have hit a record high, as more than 1,000 people waited at least 12 hours to be seen by a doctor for the first time since records began. Official statistics released yesterday show the proportion of people left waiting more than eight and 12 hours in December were at the worst level for a single month since records started in 2007. Patients who were seen within the four-hour waiting time target also reached the lowest level on record. Scottish Conservatives health spokesman Miles Briggs described the figures as "an utter disaster". Mr Briggs said: "Patients are waiting in pain, discomfort and distress which in turn significantly affects staff." Read full story Source: The Telegraph, 4 February 2020
  14. News Article
    Up to half of all patients who suffer an acute aortic dissection may die before reaching crucial specialist care, according to a new Healthcare Safety Investigation Branch (HSIB) report. The report highlights the difficulty which can face hospital staff in recognising acute aortic dissection. The investigation was triggered by the case of Richard, a fit and healthy 54-year old man, who arrived at his local emergency department by ambulance after experiencing chest pain and nausea during exercise. It took four hours before the diagnosis of an acute aortic dissection was made, and he spent a further hour waiting for the results of a CT scan. Although Richard was then transferred urgently by ambulance to the nearest specialist care centre, he sadly died during the journey. The report has identified a number of risks in the diagnostic process which might result in the condition being missed. These include aortic dissection not being suspected because patients can initially appear quite well or because symptoms might be attributed to a heart or lung condition. It also highlighted that, once the diagnosis is suspected, an urgent CT scan is required to confirm that an acute aortic dissection is present. Gareth Owens, Chair of the national patient association Aortic Dissection Awareness UK & Ireland, welcomed the publication of HSIB’s report, saying: “HSIB’s investigation and report have highlighted that timely, accurate recognition of acute Aortic Dissection is a national patient safety issue. This is exactly what patients and bereaved relatives having been telling the NHS, Government and the Royal College of Emergency Medicine for several years." Read full story Source: HSIB, 23 January 2020
  15. News Article
    Plans to scrap the four-hour A&E target have sparked a furious backlash from doctors and nurses, with some claiming it is driven by ministers’ desire to avoid negative publicity about patients facing increasingly long delays. A&E consultants led a chorus of medical opposition to the move. They pointedly urged NHS leaders and ministers to concentrate on delivering the long-established maximum waiting time for emergency care rather than finding “ways around” it. Under the target, 95% of people arriving at A&E in England are meant to be treated and then discharged, admitted or transferred within four hours. But performance against the target plunged to a new record low of just 68.6% last month in hospital-based A&E units as a result of staffing problems, the decade-long squeeze on the NHS budget and the dramatic growth in the number of patients seeking care. The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, was responding to Wednesday’s apparent confirmation by the health secretary, Matt Hancock, that the target is set to be axed because it is no longer deemed to be “clinically appropriate”. “So far we’ve seen nothing to indicate that a viable replacement for the four-hour target exists and believe that testing [of alternatives to the target] should soon draw to a close,” said Dr Katherine Henderson, the President of the RCEM. “Rather than focus on ways around the target, we need to get back to the business of delivering on it.” The Emergency Care Association, to which 8,000 A&E nurses belong, said ministers should exercise “extreme caution” in decisions about the target because “it could cause significant detriment to patient safety within our emergency departments if the four-hour target was abolished”. There are fears that patients thought to have only minor ailments could come to harm by having to wait a lot longer than four hours because they also have a more serious condition. Read full story Source: The Guardian, 15 January 2020
  16. News Article
    The first publication of data from the Royal College of Emergency Medicine’s 2019-20 Winter Flow Project shows that existing data does not reflect the true scale of the problem of 12 hour stays in A&E. RCEM data shows that in the first week of December over 5,000 patients waited for longer than 12 hours in the Emergency Departments of 50 Trusts and Boards across the UK. The sample of trusts and boards from across the UK is the equivalent to a third of the acute bed base in England. From the beginning of October 2019 over 38,000 patients have waited longer than 12 hours for a bed at the sampled sites across the UK – yet data from NHS England reports that in England alone a total of only 13,025 patients experienced waits over 12 hours since 2011-12. President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “In a nine-week period, at only a third of trusts across the UK, we’ve seen nearly three times the number of 12 hour waits than has been officially reported in eight years in England. This must be fixed." Read full story Source: Royal College of Emergency Medicine, 9 December 2019
  17. News Article
    A "life-changing" mental health service at three hospitals in north Wales is to be expanded to GP surgeries. More than 2,500 people have used 'I Can' centres at Glan Clwyd, Gwynedd and Wrexham Maelor hospitals since the trial was launched earlier this year. The centres offer support to patients at A&E departments who may not require medical treatment or a bed. They employ both volunteers and paid staff, many of whom have experienced mental health issues themselves. Betsi Cadwaladr University Health Board said the service allowed people to talk about mental health issues away from wards. It hopes extending the scheme to GP surgeries and community hubs will allow people to get support close to home if they do not need medical treatment. Read full story Source: 9 December 2019
  18. News Article
    A 99-war-old war veteran was left in agony on an A&E trolley in a hospital for almost 10 hours. Brian Fish, a former captain in the Royal Engineers, was left “crying out in pain” as he endured the long wait at Margate’s Queen Elizabeth Queen Mother Hospital, his daughter said. Mr Fish had been urgently admitted to hospital with gall bladder problems. Details of his ordeal emerged as figures showed the queues at NHS emergency departments are now the longest on record, with one in four patients at major A&Es waiting longer than four hours to be seen or treated in October. His daughter Hilary Casement, who witnessed her father’s hospital ordeal, said: “It was traumatic for him. He lay for hours crying out in pain on a hard trolley. Eventually, with much pleading from me, he was transferred, actually tipped, on to a slightly more comfortable hospital bed and eventually seen by the kind, but overworked, medical team". Read full story Source: The Independent, 19 November 2019
  19. Content Article
    This article in the journal Patient Safety describes a state-wide, population-based study into tracheostomy- and laryngectomy-related airway safety events. The Pennsylvania-based study aimed to assess the relationship of these events with associated factors, interventions and outcomes, to identify potential areas for improvement. The authors queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) to find tracheostomy- and laryngectomy-related airway safety event reports involving adults age 18 years and older that occurred between 1 January 2018, and 31 December 2020.
  20. Content Article
    Dr Katherine Henderson is a senior A&E consultant in London and the president of the Royal College of Emergency Medicine. In this article for The Guardian, she describes the deep crisis facing urgent and emergency care in the UK. She describes hospital warnings of dangerous delays that have seen vulnerable patients waiting hours to be seen and admitted to hospital. This is dangerous, frustrating and undignified for patients, but also distressing for staff, who are finding themselves unable to offer the quality of care they want to deliver. Dr Henderson attributes the issues to shortfalls in healthcare staff and hospital beds, but also a lack of capacity in community care that is delaying patients being discharged from hospital. The situation is exacerbated by staff absence due to Covid-19. To tackle the crisis, she calls for clear plan to increase bed capacity and a robust, fully funded long-term workforce plan.
  21. Content Article
    Putting patients in tents outside hospitals is a completely unacceptable ‘solution’ to the ambulance handover problems and the funding would be far better spent on staff in the community, says Royal College of Emergency Medicine president Katherine Henderson in this HSJ opinion piece.
  22. Content Article
    This investigation by the Healthcare Safety Investigation Branch (HSIB) explores the timely recognition and treatment of suspected pulmonary embolism in emergency departments. Pulmonary embolisms can form when clots from the deep veins of the body, usually originating in the legs, travel through the venous system and become lodged in the lungs. A person suffering from a pulmonary embolism requires urgent treatment to reduce the chance of significant harm or death.
  23. Content Article
    This report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a pilot launched to evaluate HSIB’s ability to carry out effective local investigations at specific hospitals and trusts, while still identifying and sharing relevant national learning. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. The investigation reviewed the case of a patient who had a stroke and was due to be taken to his local hospital emergency department (ED), but the ED advised paramedics this was not possible as their stroke service was closed. The alternative was to take him to a neighbouring hospital, but they also advised that they could also not take the patient. This was then referred back to the original ED, who restated their position, eventually leading to the neighbouring hospital agreeing to accept the patient. Once the patient arrived he then had to wait 40 minutes in an ambulance as the ED was very busy.
  24. Content Article
    Chloe Lumb was known to have a genetic risk of aortic dissection that was being monitored. When she presented to James Cook University Hospital in Middlesbrough on 4 January 2021 a diagnosis of aortic dissection was not made, despite the prior knowledge about her risk and her clinical symptoms. The next day she contacted the hospital following discharge because of ongoing symptoms but was not asked to return to hospital. In her report, the Coroner states that a diagnosis of aortic dissection and appropriate surgical treatment would have prevented Ms Lumb’s death.
  25. Content Article
    This report by the British Red Cross highlights the impact of deprivation and inequality on high intensity use of accident and emergency services (A&E), and the additional cost and strain this puts on these services. It shows that people from the most deprived areas of the UK and people with mental health issues are more likely to be in poor health and are most likely to attend A&E frequently. The report calls for better support for people who frequently attend A&E because they feel they have 'nowhere else to turn'.
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