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Found 420 results
  1. News Article
    Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays. In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”. The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls. The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working. “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.” Read full story (paywalled) Source: HSJ, 11 December 2023
  2. News Article
    Patients needing emergency treatment are becoming sicker in A&E as hospitals struggle to free up enough beds, top doctors have warned. Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), told The Independent that elderly patients are waiting so long for treatment in A&E that they’re developing bed sores and delirium. Another senior NHS doctor, Dr Vicky Price, who is president-elect of the Society for Acute Medicine, warned that corridor care is now “routine practice” with the situation only set to worsen as A&E departments come under increasing pressure. Their comments highlight the ongoing chaos in emergency medicine, as strikes take place during the most difficult time of the year. The chief executive of the NHS, Amanda Pritchard, said on Thursday that last winter was the worst she’d ever seen for the health service, warning that strikes by junior doctors will only make the situation harder for hospitals this year The warnings come as the latest NHS data shows that the prime minister, Rishi Sunak, could fail in his promise to deliver 5,000 more acute hospital beds to the NHS this month. Current data shows that the NHS is falling short of the target by just under 1,200 beds, with 97,818 against a target of 99,000. Read full story Source: The Independent, 10 November 2023
  3. News Article
    Almost 8,000 people were harmed and 112 died last year as a direct result of enduring long waits for an ambulance or surgery, prompting warnings that NHS care delays are “a disaster”. The fatalities included a man who died of a cardiac arrest after waiting 18 minutes for his 999 call to be answered by the ambulance service and was dead by the time the crew arrived. The figures are the first time NHS England has disclosed how often doctors and nurses file a patient safety report after someone suffers harm while waiting for help. They show that patient deaths arising directly from care delays have risen more than fivefold over the last three years, from 21 in 2019 to 112 last year, as the NHS has come under huge strain. The number of people who came to “severe harm” has also jumped from 96 to 152 during that period. “These data are alarming and show quite clearly the human impact the crisis in the NHS is having on individual patients,” said Rachel Power, the chief executive of the Patients Association. “We have been watching a disaster unfolding across the NHS and have repeatedly warned about the threat to patient safety because of it.” Read full story Source: The Guardian, 27 November 2023
  4. News Article
    Several trusts are failing to admit their sickest emergency patients in a timely fashion, despite performing well in official waiting time statistics, HSJ can reveal. The internal NHS England data, obtained via a Freedom of Information request, reveals 12 trusts which have performed above the average against the four-hour accident and emergency target are delivering relatively poor waiting times for patients who require admission, as opposed to those who, for example, can be discharged after being seen. The unpublished provisional data shows an average of just 30% of admitted patients in England spend four hours or less in A&E against the 95% target. But many trusts are falling significantly below this – including those trusts at or around NHSE’s interim target of 76% for four hours performance for all patients by March 2024. Read full story (paywalled) Source: HSJ, 24 November 2023
  5. News Article
    Doctors have sent a stark warning over the dire state of emergency care for mental health patients after half of A&Es revealed patients were waiting more than five days in hospital before getting the treatment they need. The “truly alarming” figures, shared exclusively with The Independent, show vulnerable patients are being let down by “unacceptable delays” to their treatment, with one campaigner warning the issue has become a national emergency. The data, collated by the Royal College of Emergency Medicine (RCEM), prompted a bleak verdict from top doctor Dr Adrian Boyle who said the system – which sees patients being cared for by A&E staff who are not specifically trained for their needs – was failing the most “fragile” patients. Warning that mental health patients are being hit the hardest by long waits in A&E, Dr Boyle, the RCEM president, added: “These patients need effective and efficient care, they deserve compassionate care – crucially, they deserve better.” Read full story Source: The Independent, 20 November 2023
  6. Content Article
    This report by the Royal College of Emergency Medicine presents insights about Emergency Department (ED) crowding in England. It highlights that overcrowding is a major threat to public health and outlines the reasons for overcrowding - primarily increasing patient demand coupled with high hospital bed occupancy, which has resulted in exit block.
  7. News Article
    Hospitals are being prevented from adopting models which spread risk away from emergency departments because other teams refuse to take on the extra work, according to a top accident and emergency doctor. In a recent interview with HSJ, North Bristol Trust chief executive officer Maria Kane praised her trust’s risk-sharing approach to emergency care, which involves moving patients each hour from accident and emergency to the most appropriate ward for their needs and where a discharge is expected, even if it is full. Commenting on the article, Royal College of Emergency Medicine president Adrian Boyle said: “The NBT trust leadership deserve significant credit for maintaining this. All too often there is an acceptance of unacceptable delays (and risk) in ambulance handovers and long ED stays. “Where this fails, it is usually because inpatient teams (both nursing and medical) have objected to the extra workload, without appreciating the real harm elsewhere. The more interesting question is why isn’t this being done more widely?” Read full story (paywalled) Source: HSJ, 15 November 2023
  8. Content Article
    A pulmonary embolism happens when a blood clot breaks off and travels to the lungs where it blocks the flow of blood. Although life-threatening, when diagnosed promptly survival rates are good. This report from the Parliamentary and Health Service Ombudsman (PHSO) looks at the case of a man who died of a pulmonary embolism after doctors failed to test for deep vein thrombosis.
  9. 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.
  10. Content Article
    The Greater Manchester Major Trauma Network recognise that many older patients self-present to emergency departments and the ‘Meet Harry’ infographic was produced as an aide memoire to triage nurses and clinicians to assist in assessment. You can view the ‘Meet Harry’ infographic by clicking on the image or download it from the attachment below.
  11. News Article
    Community clinics credited with easing pressure on A&E and GP practices nationally last winter have not yet been funded for this year, and many may not be able to open, HSJ has learned. Several local and regional sources said they were concerned no funding had been announced for acute respiratory hubs, despite respiratory illness already starting to rise. Last year national funding was announced in December and – despite the late notice – NHS England collected evidence showing that, once they were opened, ARI hubs reduced acute respiratory infection attendances by up to two-thirds, and released GP appointments. The hubs, normally held at community clinics, offer urgent same-day appointments for those with suspected ARI problems to patients referred in by other services. David Bramley, deputy director in NHSE’s NHS@Home team, said on a webinar on Tuesday: “This year, perhaps unsurprisingly, we are seeing ARI rates beginning to climb… but we’re also not expecting any additional funding for ARI hubs this year.” Read full story (paywalled) Source: HSJ, 10 November 2023
  12. News Article
    A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ. Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023. The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system. She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.” Read full story (paywalled) Source: HSJ, 8 November 2023
  13. News Article
    Long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year, according to new estimates. Using a methodology backed by experts, HSJ analysis of official data has produced an estimate of 29,145 ‘excess deaths’ related to long accident and emergency delays in 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21. For the first time, the analysis has also produced estimates of excess mortality related to long A&E delays for every acute trust. The data suggests the rate of excess deaths from 2022-23 has so far continued into 2023-24. The analysis followed a methodology used in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days. Data scientist Steve Black, one of the authors of the EMJ study, said: “Long waits in A&E should never happen and 12-hour waits should be something like a never event. They should be intolerable anywhere. If we want to fix them it’s helpful to know which trusts have the worst problems with long waits.” Read full story (paywalled) Source: HSJ, 7 November 2023
  14. News Article
    NHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim. Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe. How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals. That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter. The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, wants that system scrapped. It is urging NHS England to start publishing data that shows the true performance of every individual emergency department against the 95% standard. “The current data is misleading,” Dr Adrian Boyle, the college’s president, told the Guardian. “It’s a good example of a lack of transparency and also of performance incentives. Being open about the long delays in some A&Es would shine a light in some dark places.” Read full story Source: The Guardian. 28 October 2023
  15. News Article
    The true picture of A&E waiting times in Wales has been seriously under-reported for a decade, the BBC can reveal. The Royal College of Emergency Medicine (RCEM) has established thousands of hours are missed from monthly figures. Senior A&E doctors have been raising the issue for months. The Welsh government said it would ask health boards for assurances they were following the guidance "to ensure the data is absolutely transparent". The RCEM said it could not measure "how bad" things were because thousands of patients subject to so-called "breach exemptions" were not included in the overall A&E waiting times. The Welsh government initially disputed the RCEM's claim, but after seeing detailed figures - which were obtained through freedom of information (FOI) requests to health boards - it changed its position. Wales' health minister has repeatedly claimed A&E waiting times in Wales have "bettered English performance". But once the missing data is taken into account, it suggests the performance in Wales is worse. Read full story Source: BBC News, 16 October 2023
  16. News Article
    The NHS in England is facing mounting pressure amid a surge in patients attending A&E departments with minor ailments, health bosses have said. Emergency departments, which are designed for serious injuries and life-threatening emergencies only, are seeing an increase in people attending with sore throats, insomnia, coughs and earache. Data analysed by the Press Association news agency also shows more people going to A&E with complaints such as hiccups, nasal congestion, backache and nausea. Cases where sore throat was the chief complaint rose by 77% between 2021-22 and 2022-23, from 191,900 cases to 340,441. Patients going to A&E with coughs rose by 47%, from 219,388 to 322,500, while attendances for nosebleeds rose by a fifth, from 47,285 cases to 56,546. Miriam Deakin, the director of policy and strategy at NHS Providers, said: “The rise in A&E admissions is piling even more pressure on to an already stretched NHS. Persistent strain on primary care services, including GPs and dentists, means patients often resort to A&E when they cannot access timely care elsewhere. “Minor ailments such as coughs, earache, fever, nausea and hiccups can and should be managed through more appropriate services such as pharmacies and NHS 111 online. This could ease pressure on emergency departments, whose priority is to deliver urgent care for those most in need. Boosting capacity of staff, beds and equipment in these settings would also significantly help. However, this requires proper funding and support from the government.” Read full story Source: The Guardian, 10 October 2023
  17. News Article
    Ambulance chiefs say handover delays have got worse at some trusts in recent months, despite the picture improving nationally since last winter. A report from the Association of Ambulance Chief Executives says there are continuing concerns about handover delays at emergency departments. Jason Killens, the body’s lead chief executive for operations, told HSJ: “There’s been some improvement [at some sites] since February, but what we’ve also seen is a commensurate or bigger decay in other sites across that same period.” Mr Killens said “it’s difficult to be precise” about why some trusts have struggled more than others but that challenged hospitals are often affected by “pathway issues” including delayed discharges. “And then maybe there are challenges around stable leadership or the visibility of the leadership, the culture there about managing that risk dynamically, and so on,” he added. Read full story (paywalled) Source: HSJ, 14 September 2023
  18. News Article
    Thousands of people unaware they have type 2 diabetes could be diagnosed and avoid serious complications if screening was introduced in emergency departments, a study suggests. The prevalence of the disease has risen dramatically in countries of all income levels in the last three decades, according to the World Health Organization. More than 400 million people have been diagnosed, but millions more are estimated to be in the dark about the fact they have the condition. A study that took place in an NHS trust in England suggests 10% more cases could be picked up with the use of a simple blood test. Screening could also pick up 30% more cases of pre-diabetes – a serious condition where blood sugar levels are higher than normal. The findings are being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany. “Early diagnosis is the best way to avoid the devastating complications of type 2 diabetes, and offers the best chance of living a long and healthy life,” said Prof Edward Jude, of Tameside and Glossop integrated care NHS foundation trust. Read full story Source: The Guardian, 3 October 2023
  19. Content Article
    Overcrowding in the emergency department (ED) is a global problem that causes patient harm and exhaustion for healthcare teams. Despite multiple strategies proposed to overcome overcrowding, the accumulation of patients lying in bed awaiting treatment or hospitalisation is often inevitable and a major obstacle to quality of care. This study in BMJ Open Quality looked at a quality improvement project that aimed to ensure that no patients were lying in bed awaiting care or referral outside a care area. Several plan–do–study–act (PDSA) cycles were tested and implemented to achieve and maintain the goal of having zero patients waiting for care outside the ED care area. The project team introduced and adapted five rules during these cycles: No patients lying down outside of a care unit Forward movement Examination room always available Team huddle An organisation overcrowding plan The researchers found that the PDSA strategy based on these five measures removed in-house obstacles to the internal flow of patients and helped avoid them being outside the care area. These measures are easily replicable by other management teams.
  20. Content Article
    The Association of Ambulance Chief Executives (AACE) has published a new report charting the major increase in the frequency and length of hospital handover delays over the past ten years, calling for an even greater focus on improvements that will reduce and eradicate delays, prevent more patients from coming to significant harm and stop the drain on vital ambulance resources.
  21. News Article
    ChatGPT could be used to diagnose patients in a bid to reduce waiting times in emergency departments, researchers have suggested. It comes after a study found the language model, powered by artificial intelligence (AI), “performed well” in generating a list of diagnoses for patients and suggesting the most likely option. Researchers in the Netherlands entered the records of 30 patients who visited an emergency department in 2022, as well as anonymous doctors’ notes, into ChatGPT versions 3.5 and 4.0. The AI analysis was compared to two clinicians who made a diagnosis based on the same information, both with and without laboratory data. When lab data was included, doctors had the correct answer in their top five differential diagnoses in 87% of cases, compared with 97% for ChatGPT 3.5 and 87% for ChatGPT 4.0. There was a 60% overlap between the differential diagnoses by clinicians and ChatGPT. The team said that while ChatGPT was “able to suggest medical diagnoses much like a human doctor would”, more work is needed before it is applied in the real world. Read full story Source: The Independent, 13 September 2023
  22. Content Article
    Delays in the handover of patient care from ambulance crews to emergency departments (EDs) are causing harm to patients. A patient’s health may deteriorate while they are waiting to be seen by ED staff, or they may be harmed because they are not able to access timely and appropriate treatment. This national investigation sought to examine the systems that are in place to manage the flow of patients through and out of hospitals and consider the interactions between the health and social care systems (the ‘whole system’). This report brings together the findings from the investigation’s three interim reports and provides an update since they were published. You can view the interim reports on the hub: Interim report 1 (16 June 2022) Interim report 2 (3 November 2022) Interim report 3 (27 February 2023)
  23. News Article
    A group of senior doctors has accused NHS Grampian of ignoring their safety concerns about emergency departments. They told BBC Scotland News they were speaking out because they feel they cannot deliver a safe level of care. The medics said staff shortages meant Grampian's two A&Es have no senior registrars on shift to make key decisions about patients for the majority of weekend night shifts. Documents seen by the BBC News show medics have been raising concerns since 2021, both with NHS Grampian and the Scottish government, and in July this year submitted a formal whistleblowing complaint about the situation. One doctor said: "The staff are in an impossible situation. "We are witnessing ongoing harm with unacceptable delays to the assessment and treatment of patients. "There have been avoidable deaths and at other times there are too long delays getting to patients who may be suffering from a serious condition like stroke or sepsis." Read full story Source: BBC News, 23 August 2023
  24. Content Article
    The aim of this study from Hutchinson et al. was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department.
  25. Content Article
    Authors conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. The primary outcomes of interest were the proportion of admitted patients, that is, the admission rate, the length of stay in the ED and ambulance handover times. They used interrupted time series models to study and estimate the impact of removing the 4-hour access standard.
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