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Found 435 results
  1. 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.
  2. 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.
  3. News Article
    The chief executive of three NHS trusts says ringfencing elective care within an acute hospital site is potentially more ‘productive’ than sending it to a separate ‘cold’ site. Glen Burley, who leads a “provider group” in the West Midlands, says his trusts have been grappling with the challenge of how to maximise elective activity without it being disrupted by emergency pressures. The conventional view – as outlined in the NHS long-term plan – is that performing more elective care on a separate site from emergency can help ensure theatre lists are not disrupted. But George Eliot Trust, which has been led by Mr Burley since 2018 and only has a single district general hospital, has created a “ringfenced” elective hub within the site. In an interview with HSJ, Mr Burley said: “So I actually think the most productive model in the NHS is if you can pull that off. “If you can actually protect your elective capacity and offer it on the same site [as] urgent care, so the clinicians are not having to move between sites, you’ve got optimal productivity. “The challenge right across the NHS has been avoiding that spillage, of emergency care into your elective capacity. “As you get busier and you escalate… the order in which you encroach into areas that you should not encroach into, is really key in that. We are saying we are going to protect our elective beds in a way that we haven’t done before." Read full story (paywalled) Source: HSJ, 14 March 2022
  4. 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.
  5. Content Article
    In this blog, Jayne Flood, Falls Prevention Practitioner at East Kent Hospitals NHS Foundation Trust, describes how her team introduced ‘yellow kits’* to assist patients at high risk of falls in A&E, and evaluated their impact. *Developed in partnership with Medline Industries Ltd.
  6. News Article
    NHS England’s plan to make the 111 service a ‘primary route’ into emergency departments has fallen ‘far short of aspiration’, with only a small fraction of attendances being booked through it. NHSE began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”. Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70% of patients referred to ED by 111 services should receive a booked time slot to attend. Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected. Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking. Jacob Lant, head of policy and research at Healthwatch England, said: “Sadly, it’s clear from these figures that implementation across the country is lagging behind where we would have hoped. “Obviously this has to be seen in the context of the massive pressures on A&E departments at the moment as a result of the pandemic, but there is also a need for the NHS to really step up efforts to tell people about this new way of accessing care.” Read full story (paywalled) Source: 25 February 2022
  7. News Article
    A life-saving campaign is being launched by the NHS to urge people to learn how to spot signs of a heart attack. The survival rate for heart attack sufferers is seven in 10, rising to nine in 10 for those who have early hospital treatment. The most common sign of a heart attack is chest pain, but other symptoms to look out for include chest, arm, jaw, neck, back and stomach pain, lightheadedness or dizziness, sweating, shortness of breath, nausea, vomiting, anxiety, coughing and wheezing. The health service are encouraging anyone experiencing these indicators to call 999. It comes after a poll found found that fewer than half of people knew to dial 999 if they or a loved one experienced the more vague signs of a heart attack. Another priority of the campaign is to teach people how to differentiate between a heart attack and cardiac arrest. According to the health service, there is often no warning and the person quickly loses consciousness when they suffer cardiac arrest. Those experiencing a cardiac arrest will usually die within minutes if they do not receive treatment. It also points out that a heart attack can lead to a cardiac arrest. NHS medical director Professor Stephen Powis said: “Sadly, cardiovascular disease causes a quarter of all deaths across the country and we have identified this as the single biggest area where we can save lives over the next decade. Read full story Source: 13 February 2022
  8. News Article
    The number of 12-hour waits in accident and emergency departments rose by 27% in one month to reach record levels in January amid warnings overcrowding is harming an increasing number of patients. Official monthly performance data prompted the Royal College of Emergency Medicine’s president to warn that the problems facing emergency departments were getting “worse and worse”, while pointing out the real number of 12-hour A&E breaches is likely higher than official data records. The figures also revealed the waiting list had hit a new high of 6.1 million, while the number of two-year breaches also rose a record level. Trusts recorded 16,558 patients last month waited 12 hours or more in an emergency department from decision to admit to being discharged or admitted. This was up from 12,986 in December. RCEM president Katherine Henderson warned on Twitter: “This is [decision to admit] plus 12 – a concept which must be retired as a performance metric. We should have 0-12 hour data. You cannot fix a problem if you [are] unwilling to face up to what it actually is. We estimate reality is 20 x more. This is getting worse and worse.” Read full story (paywalled) Source: HSJ, 10 February 2022
  9. News Article
    A hospital trust has apologised to a mental health patient who reported being sexually assaulted in its A&E department – after it emerged in a safety review that staff wrote ‘this has not happened’ and dismissed her claims of the attack. The victim was admitted to West Suffolk Hospital’s emergency department following an overdose in January last year. While waiting in A&E for a mental health assessment from a specialist team employed by Norfolk and Suffolk Foundation Trust, she reported being sexually assaulted by a male patient who had also been admitted to A&E. Yet a review into the incident, published several months later and shared with HSJ, reveals that after the victim reported the attack to a nurse, the staff member recorded “this has not happened”. They stated that the male suspect in the cubicle next to her had not left his bed and was under constant observation. However, the patient safety review, drawn up after a serious incident probe was launched, adds that this statement was “incorrect, as the [male] patient was not under constant observation”. “There were witnesses to this incident, and CCTV, and yet it was not escalated until I contacted the trust myself to complain,” the victim said. She added that she pursued the complaint, which resulted in a serious incident probe that took several months to conclude, “to prevent others from being failed” in the same way. She said she was left “shocked, confused and furious” to discover staff had dismissed her assault and claimed the male suspect had not been admitted for an assessment on the day of the attack. Read full story (paywalled) Source: HSJ, 7 February 2022
  10. News Article
    Long waits at accident and emergency (A&E) departments in Scotland continue to put patient safety at “serious risk”, the Royal College of Emergency Medicine has warned. New figures from Public Health Scotland show 78 per cent of patients visiting A&E in the week to January 23 were seen and admitted, transferred or discharged within four hours. This is an increase on the previous week, but still below the Scottish Government target of 95% It comes as the number of planned operations across NHS Scotland dropped 13% from November to December, to 17,835. Dr John Thomson, vice-president of the Royal College of Emergency Medicine in Scotland, said the college was concerned poor A&E performance times are becoming the “status quo”. “With fewer attendances performance has plateaued, but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout,” he said. Dr Thomson added: “The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients. Read full story Source: The Scotsman, 2 February 2022
  11. News Article
    Bina Patel, aged 56, died after struggling to breathe and waiting almost an hour for an ambulance. Her son Akshay Patel has shared the six phone calls he made to North West Ambulance Service on the night of her death. North West Ambulance say they "can never say sorry enough" for Bina's death. "The amount of time it took for help to arrive is unacceptable and not how we want to care for our patients," a spokesperson said. View video Source: BBC News, 26 January 2022
  12. News Article
    The four-hour standard for A&E waits is the ‘wrong target’, which ‘doesn’t work’ and leads to ‘perverse outcomes’, health and social care secretary Sajid Javid has said. Mr Javid made the claim during an appearance before the Commons health and social care committee yesterday. He also spoke about the requirement that NHS patient-facing staff must be vaccinated against covid and took the opportunity to restate his belief that radical action was needed to tackle “failing trusts”. Mr Javid told the MPs: “Targets work if they are the right targets, and in the NHS I have already noticed there are targets which are the wrong targets and we’ve got to change them. “The four-hour A&E target is the wrong target, it doesn’t work. It leads to really perverse outcomes. “If you look at some NHS trusts, all of sudden when the individual in A&E has got to three hours and 55 minutes, guess what? They just admit it. That’s a poor outcome. “There may have been a good reason to have that target in the past, but you’ve got to keep these targets constantly under review and that’s something I’m doing.” The long-running clinical review of waiting time standards by NHS England had proposed replacing the four-hour target with a suite of other measures but the government has yet to formally respond. Read full story (paywalled) Source: HSJ, 26 January 2022
  13. Event
    until
    This is the third in a series of online lectures organised by the International Shared Decision Making Society (ISDM). This lecture will be hosted by Kristen Pecanac, UW-Madison School of Nursing. Join the webinar
  14. Content Article
    This report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a local pilot, which has been launched to evaluate HSIB’s ability to carry out effective investigations occurring between specific hospitals and trusts. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. On her admission to her local emergency department (ED) after a fall at her nursing home, Mrs E, a woman aged 93 with dementia, was booked into the ED with incorrect patient details, resulting in a new patient record being created. She was discharged that day but readmitted the next day after a second fall. She was booked into ED with the new patient record (which contained the incorrect patient details) and had an x-ray which confirmed she had a broken hip, subsequently being admitted to hospital for surgery. Mrs E had surgery the next day, during which the pathology department identified a problem with the accuracy of her patient identification information and following surgery her two sets of patient records were merged.
  15. News Article
    A troubled integrated care system has been told it must provide more help to a severely under-pressure acute trust where patients were treated on the floor and in a storeroom. The Care Quality Commission said Devon ICS must give more “input” to University Hospitals Plymouth Trust, where inspectors warned staff could “not ensure the safety of all patients” arriving at the emergency department. During a visit to the trust’s Derriford Hospital in September, inspectors saw staff treating six patients who “lay on the floor” of the ambulatory assessment unit, while another patient who had been in the department overnight was being “treated/assessed in the ‘storeroom’” – according to the CQC’s report. Inspectors reported: “The department was overcrowded, there was no seating available… Social distancing was not possible.” While the CQC praised senior leaders in the ED and executive chiefs for being “open to challenge” and “understanding the problems” faced by the urgent and emergency care service, inspectors said there was only so much the trust could do alone. Catherine Campbell, head of hospital inspection at CQC, said: “The impact of a high number of patients attending to receive care, combined with reduced staffing levels in the ED, created issues that the trust couldn’t solve alone and further support was needed from the local health and social care system." Read full story (paywalled) Source: HSJ, 19 January 2022
  16. Content Article
    Delays to timely admission from emergency departments (EDs) are known to harm patients. In this study, Jones et al. assessed and quantified the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England.
  17. News Article
    Hospitals are not able to cope with current pressures, senior doctors have warned, as a new study links long A&E waits to an increased risk of death. Patients waiting more than five hours within an emergency department are at an increased risk of dying, according to a study published in the Emergency Medicine Journal (EMJ). The study’s findings come as emergency care performance across England continues to deteriorate, and as pressures across hospitals mean that more patients are waiting for more than four hours in A&E departments than ever before. According to the research, death rates for patients waiting between six and eight hours before admission to hospital were 8% higher, and they were 10% higher for those waiting eight to 12 hours. The study was based on data collected prior to the pandemic, and national A&E waiting times have since deteriorated further. In November last year, the Royal College of Emergency Medicine (RCEM) warned that long delays and overcrowding in A&Es may have caused thousands of deaths during the pandemic. Researchers said that although cause and effect could not be established between longer waits and deaths after 30 days of hospital admission, they recognised a statistically significant trend. The paper said: “Long stays in the emergency department are associated with exit block and crowding, which can delay access to vital treatments. And they are associated with an increase in subsequent hospital length of stay, especially for older patients. Read full story Source: The Independent, 19 January 2022
  18. News Article
    An ambulance trust has apologised after a man having a heart attack said he was advised to get a lift to hospital or face a long wait. Graham Reagan said he was on the verge of collapsing when he finally got to York hospital after a lift from his son. Mr Reagan said he was concerned about the impact on patients with potentially life-threatening conditions. Speaking to BBC Yorkshire and Lincolnshire's Politics North programme, Mr Reagan described his experience as "scary". "I'd had indigestion, or so I thought, for a couple of days, and then on 17 December I went to bed early feeling rough," he said. In the early hours, Mr Reagan said the pains in his chest grew worse and he asked his wife to call for an ambulance. "I couldn't take it any more," he said. Mr Reagan, from Malton in North Yorkshire, said his wife was asked "can you get to hospital" as the nearest ambulance was about 20 to 30 miles away. "My wife doesn't drive, but fortunately my son was with us and he drove me to York hospital." On arrival Mr Reagan said they found the entrance to A&E had also been re-routed. "So, we then had to walk out of the hospital grounds and back in - by which time I'm collapsing," he added. He said staff at the hospital were "absolutely brilliant" and arranged for him to be transferred to Hull for treatment after a heart attack was confirmed. However, he said he was faced with a further 35-minute delay while he waited for an ambulance to take him. Mr Reagan said he wanted to share his experience to raise awareness. Read full story Source: BBC News, 16 January 2022
  19. News Article
    A hospital rated inadequate by inspectors two years ago has been praised for making improvements. The Care Quality Commission (CQC) has welcomed changes in urgent and emergency care at Stepping Hill Hospital in Stockport, Greater Manchester. The trust said the report was a "testament" to its staff's hard work. The CQC's unannounced inspection in November was carried out to check improvements had been made since a previous visit in August 2020. Among the concerns highlighted previously were patients left at high risk of harm during periods of heavy demand, staff shortages and staff who were "not competent for their roles". The new report said inspectors found urgent and emergency care had improved from inadequate to good overall and for being safe and well-led. "It has gone from requires improvement to good for being effective and caring. Responsive has gone from inadequate to requires improvement," the report said. Karen Knapton, CQC's head of hospital inspections, said: "We acknowledge the efforts of the emergency care team at Stepping Hill Hospital. We found staff provided good care and treated people with compassion and kindness." "They gave patients, their families and carers help, emotional support and advice when they needed it. Also, the service has been tailored to meet individual needs, including those living with dementia or a learning disability. " Read full story Source: BBC News, 12 January 2022
  20. News Article
    NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave. The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds. This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients. The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”. Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111. Read full story (paywalled) Source: HSJ, 7 January 2022
  21. News Article
    Nearly a quarter of patients brought to hospital in an ambulance are facing dangerous delays getting into hospital in England, NHS data shows. Ambulances are meant to hand over patients within 15 minutes of arriving. But in the past week 23% out of nearly 84,000 patients brought in waited over 30 minutes. Staff are warning patients are being put at risk by the delays - and they think the situation is only going to get worse as Covid infections rise. At seven NHS trusts more than half patients were left waiting over half an hour with nearly two thirds delayed at Gloucestershire Hospitals NHS Trust. Association of Ambulance Chief Executives managing director Martin Flaherty said the situation was a major concern. "The extent of potential harm that is being caused to patients when there are lengthy delays remains a significant and growing problem." He said work was going on to tackle the issue, but around a quarter of hospitals were really struggling. Read full story Source: BBC News, 16 December 2021
  22. Content Article
    University Hospitals Leicester NHS Trust has published a guide to help parents and carers know what to do when young children fall ill. It gives advice on when and where to seek treatment for children suffering from common illnesses or injuries. The guidance, written by doctors, focuses on coughs, minor head injuries, vomiting and fever. The trust said it hoped to help families avoid long waits in A&E departments. Advice in the guide aims to help people decide whether to seek help from their GP, call 111, visit A&E or treat children at home.
  23. Content Article
    This blog calls for action on the careful review of established pain medication when a patient is admitted to hospital. Richard describes the experience of two elderly patients who suffered pain due to their long term medication being stopped when they were admitted to hospital. Pain control needs must not be ignored or undermined, there needs to be carer and patient involvement and their consent, and alternative pain control must be considered.
  24. Event
    until
    This face-to-face event by The Royal College of Emergency Medicine will look at research around burnout and other psychological impacts of working in the emergency department. It will feature talks from clinicians promoting staff wellbeing and explore opportunities to work with the Sustainable Working Practice Committee. View the event programme Book this event. Reduced fees are available for RCEM members and student members LMIC clinicians and students.
  25. News Article
    UK hospitals have cancelled at least 13,000 operations over the last two months as they struggle to cope with record demand for NHS care and people sick with Covid-19. Figures collected by A&E doctors showed that 13,061 planned surgeries had to be called off during October and November because of shortages of beds and staff. However, the cancellations occurred at just 40 of the several hundred NHS hospitals across the four home nations, so those 13,061 are likely to be a major underestimate of the scale of the problem. Dr Adrian Boyle, a vice-president of the Royal College of Emergency Medicine (RCEM), which published the data, said the cancellations represented “a stark warning for the months ahead”. He also warned that A&E units across the NHS are “verging on crisis” because of their growing inability to provide timely care to the increasing numbers of patients seeking help. “Urgent and emergency care is verging on crisis and it is impacting and derailing elective care, meaning surgery for patients with serious conditions is delayed,” he added. Read full story Source: The Guardian, 7 December 2021
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