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Found 432 results
  1. Content Article
    The Royal College of Emergency Medicine (RCEM) commissioned Ipsos to conduct an online poll of UK adults aged 16-75 to better understand their views on emergency care. The poll revealed that confidence in the UK Government’s approach to tackling long waits for patients in A&E is low, with 59% of respondents expressing a lack of confidence that the UK Government has the right policies to tackle long patient waiting times in A&E departments in hospitals. RCEM’s five priorities below for UK Governments will #ResuscitateEmergencyCare to ensure the emergency care system is there for us all in our time of need.
  2. News Article
    A major acute trust has warned ahead of next week’s nursing strike that it will face ‘very severe staffing shortages’ in children’s A&E, with ‘as few as one nurse per ward’, much less critical care capacity, and fewer operating theatres open than on Christmas Day. Cambridge University Hospitals Foundation Trust’s medical director said in a note, seen by HSJ, that the hospital would only have 60 to 70% of its critical care beds open and that “it is not possible to guarantee patient safety on our wards over the forthcoming weekend” with severe staffing shortages in “almost all areas”. The Royal College of Nursing is planning no derogations (exceptions) to its planned 48-hour walkout, from 8pm on Sunday until 8pm on Tuesday, whereas its previous action has exempted emergency care. There have been national warnings about the significant safety threat posed, but the CUH message, sent to all staff by medical director Ashley Shaw, sets out a more stark picture of critical services scaled back. It says: ”Our current information indicates there will be a severe shortage of nurses in almost all ward areas, with as few as 1 nurse per ward per shift." Read full story (paywalled) Source: HSJ, 26 April 2023
  3. Content Article
    In this article, published on Richard Smith's non-medical blogs, Richard describes the events surrounding his elderly mothers trip to A&E from her care home. Richard highlights a number of safety issues in his account and improvements that could be made to the system and processes. "The nurses have much more confidence in the benefits of the hospital than I do. Hospitals, I know, are dangerous and miserable places for everybody but particularly for the demented; and the danger is increased in the pandemic. There has to be considerable benefit to outweigh the inbuilt risk."
  4. News Article
    Around 10 per cent of the 1.2 million accident and emergency attendees in February waited 12 hours or more, newly published NHS England data has revealed, laying bare the true extent of the NHS’s emergency care crisis. The data – which NHSE has collected for years but has only now started to publish – shows 125,505 patients waited 12 hours or more from their arrival at A&E to be admitted, transferred or discharged. This is more than double the highest figure under the existing metric of around 55,000, which only starts the clock from when the patient has received a decision to admit. NHSE’s decision to publish the data for 12-hour breaches from time of arrival follows a concerted campaign by the Royal College of Emergency Medicine, which has long raised concerns the measure from decision to admit has significantly masked the true extent of long waits in A&E. Read full story (paywalled) Source: HSJ, 13 April 2023
  5. News Article
    Staff in hospital emergency departments in England are struggling to spot when infants are being physically abused by their parents, raising the risk of further harm, an investigation has found. Clinicians often do not know what to do if they are concerned that a child’s injuries are not accidental because there is no guidance, according to a report from the Healthcare Safety Investigation Branch (HSIB) that identifies several barriers to child safeguarding in emergency departments. Matt Mansbridge, a national investigator, said the report drew on case studies of three children who were abused by their parents, which he said were a “hard read” and a “stark reminder” of the importance of diagnosing non-accidental injuries quickly, since these are the warning sign in nearly a third of child protection cases for infants under the age of one. “For staff, these situations are fraught with complexity and exacerbated by the extreme pressure currently felt in emergency departments across the country,” Mansbridge said. He said the clinicians interviewed wanted to “see improvement and feel empowered” to ask difficult questions. “The evidence from our investigation echoes what staff and national leads told us – that emergency department staff should have access to all the relevant information about the child, their history and their level of risk, and that safeguarding support needs to be consistent and timely/ Gaps in information and long waits for advice will only create further barriers to care,” he said. Read full story Source: The Guardian, 13 April 2023
  6. Content Article
    Clinicians in emergency departments (EDs) will see babies and young children with injuries that may be non-accidental. If the cause of such injuries is missed, there is a risk of further harm to the child. However, making a judgement about whether an injury might be accidental or not is complex and difficult. This Healthcare Safety Investigation Branch (HSIB) investigation explores the issues that influence the diagnosis of non-accidental injuries in infants (children under 1 year of age) who visit an ED. Specifically, it explores the information and support available to ED clinicians to help them to make such a diagnosis. Due to the nature of the subject matter no specific incident was used to explore this area of care. Instead, the investigation analysed 10 serious incident reports (reports written by NHS trusts when a serious patient safety incident occurs) to identify the factors that contribute to non-accidental injuries not being diagnosed. These factors were grouped into themes, which informed the terms of reference for the investigation.
  7. News Article
    Whistleblowers have described the accident and emergency (A&E) department at Hull Royal Infirmary as "incredibly dangerous" and a "death trap". The Care Quality Commission (CSC) found Hull University Teaching Hospitals required improvement overall and its A&E department was rated inadequate. Two clinical staff members, who wished to remain anonymous, described it as a "toxic" place to work. Speaking to the BBC, the two staff members who have worked in Hull's A&E department said they had raised concerns with senior managers and the CQC. They said there were frequently fewer staff than needed and warned inexperienced staff, one whom had never seen a cardiac arrest, were working in areas like resuscitation, which was "incredibly dangerous". "Nurses who aren't even signed off to give oral medication are being put in resuscitation," one said. "It's a death trap, it is terrifying." Despite these concerns, CQC inspectors in December and November did find the service "had enough nursing and support staff to keep patients safe". Read full story Source: BBC News, 28 March 2023
  8. News Article
    Trust executives and senior managers have been criticised by a former national director for their lack of support for an under-pressure A&E. An independent review described York Hospital as “reluctant” to trigger internal escalation processes, and suggested it should be quicker to admit extra patients to inpatient wards during busy periods. Professor Matthew Cooke, a former national clinical director for emergency care who conducted the review, said that during his two-day visit to the department he witnessed a 60-hour delay for a patient to be admitted: “I was surprised not to see any senior managers or executives in the ED, despite such long delays. ED staff reported they rarely saw the executive team.” Professor Cooke also warned of uncertainty over escalation processes, including for reducing pressure in the emergency department by “boarding” patients on wards beyond normal capacity. He said: “On the second morning, there were multiple patients on oxygen in ordinary seats in majors waiting room, cared for by a single nurse. I find it difficult to understand how this is safer than boarding one extra patient on several wards.” “Staff perceived that the organisation was reluctant to move to higher escalation levels and I sensed this meant staff no longer pushed for such actions.” Read full story (paywalled) Source: HSJ, 23 March 2023
  9. News Article
    Self-harm hospital admissions for children aged eight to 17 in the UK jumped 22% in one year. The age group is now the largest for self-harm admissions, with all others seeing a drop, according to NHS data. Charities say early access to support is vital, but high thresholds and long waiting lists mean more young people are ending up in hospital. Emily Nuttal, 29, first struggled with self-harm when she was 12. At 13, she was first admitted to A&E. At that time, she was struggling with changes at school, bullying and troubles at home. Over the years, she said she had had varied experiences in accident and emergency departments. "It's been times where it's been really empathetic and passionate people, understanding, supportive. And there's been times where there's been that stigma and judgement." She said being labelled as "attention-seeking" was really difficult and made it harder to reach out for help again. "I would then only go if I was forced upon by the crisis service, or if somebody else noticed, and they got people involved," she said. Read full story Source: BBC News, 23 March 2023
  10. News Article
    The NHS’s efforts to prop up emergency departments with thousands of additional medical staff has been the wrong approach to solving the crisis in these services, experts have argued. Analysis of NHS staffing data by HSJ shows the emergency care medical workforce has grown by almost two-thirds since 2016, far outstripping the growth in other specialties. Despite this, waiting times in accident and emergency have deteriorated significantly over the same period. John Appleby, chief economist at the Nuffield Trust think tank, said: “Cramming the A&E department with more doctors doesn’t look like it’s having the intended effect over the last four to five years. Waiting times have got worse and we have more staff. “Increasing staffing has helped with waiting times in the past, but maybe we have reached a point where it’s not staffing in A&E which is the issue. The issue is the front door and the backdoor of the A&E.” Read full story (paywalled) Source: HSJ, 17 March 2023
  11. Content Article
    Cauda Equina Syndrome (CES) is a rare but serious spinal condition and if not diagnosed and treated swiftly, it can result in lifechanging injury. Nearly a quarter of compensation claims for spinal surgery in England relate to CES. This CES pathway and accompanying guidance by the Getting It Right First Time (GIRFT) programme, aims to provide healthcare professionals working in all care settings with the ability to effectively diagnose and care for patients presenting with suspected Cauda Equina Syndrome.
  12. Content Article
    In this Channel 4 Dispatches programme, secret footage filmed over the winter reveals ambulance workers battling the odds and A&E departments overwhelmed as patients suffer needless harm and death The footage comes from Daniel Waterhouse, an emergency medical technician who wore a body-mounted camera during his shifts in north-west London for three months this winter, filming every crumbling layer of a system that is close to total destruction.
  13. Content Article
    Emergency care services in the UK face an unparalleled crisis, with more patients than ever before experiencing extremely long waiting times in Emergency Departments (EDs), associated with patient harm and excess deaths. This explainer from the Royal College of Emergency Medicine (RCEM) outlines the latest data on ED waiting times and the impact this is having on patient safety.
  14. News Article
    One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors. In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM). That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month. The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital. Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”. “Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.” Read full story Source: The Guardian, 28 February 2023
  15. Content Article
    A BBC Newsnight investigation hears devastating evidence and testimony of ambulance failings in the north east of England. What does it take to run a safe service that patients can trust? 
  16. News Article
    Hundreds of thousands of older people in England are having to endure chronic pain, anxiety and unmet support needs owing to the worsening shortage of social care staff and care home beds. Age UK has said older people with chronic conditions such as diabetes, high blood pressure and heart failure are increasingly struggling with living in their own homes because of a lack of help with everyday tasks such as getting out of bed, dressing and eating. The decline in the amount of support and care provided to older people is piling pressure on families and carers and leaving the NHS in constant crisis mode, contributing heavily to ambulance queues outside A&E departments, the charity said in a new report It warned that there would be a repeat of the NHS crisis this winter – in which rising numbers of elderly people have been unnecessarily stuck in hospital because of an acute lack of social care – without a shift to preventing unnecessary admissions. Read full story Source: The Guardian, 17 February 2023
  17. Content Article
    A new in-depth report from the Charity Age UK, ‘Fixing the Foundations’, reveals how our under-funded and overstretched NHS and social care system is struggling and sometimes failing to cope with the needs of older people.  The report provides a first-hand account of older people’s difficulties in getting the good, joined up health and social care they need to manage at home, leaving them at risk of crisis which often results in being admitted to hospital. Yet the evidence is clear that with the right care at the right time many of these admissions could have been avoided. The report also includes perspectives from professionals and unpaid carers. It also shows how living with multiple long-term health conditions, as a significant proportion of older people do, including more than two-thirds of those aged over 85, makes it especially hard to navigate health services which are still usually organised around individual illnesses and diseases. Meanwhile social care was often inadequate or absent in these older people’s lives. Age UK estimates that astonishingly, over 1.6 million older people have some level of fundamental care and support need, such as help to get dressed, washed or getting out of bed, that is not being fully addressed.
  18. Content Article
    Quality improvement is a methodology used routinely in emergency departments (EDs) to bring about change to improve outcomes such as waiting times, time to treatment and patient safety. However, introducing the changes needed to transform the system in this way is seldom straightforward with the risk of “not seeing the forest for the trees” when attempting to make changes. This article in Annals of Emergency Medicine aims to demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem (“the forest”) and to support quality improvement planning, identifying priorities and patient safety risks.
  19. News Article
    Virtual wards, set up to relieve pressure on A&E departments, could create extra NHS demand as some are only staffed for 12 hours a day, the country’s top emergency doctor has warned. The service allows patients to be monitored remotely from their own homes, freeing up hospital beds and capacity in emergency departments. Patients are given devices to track their vital signs, such as blood pressure and oxygen levels, with readings sent back to doctors via smartphone apps. Dr Boyle, President of the Royal College of Emergency Medicine, said that virtual wards “must not be seen as a silver bullet for all the problems in urgent and emergency care”. “We’re very wary of virtual ward beds being used to say that there are increased beds within hospitals because that’s simply not true,” he said. “The plan for 7,000 or 5,000 extra beds need to be actual beds, with pillows, sheets and staff looking after them.” Source: Telegraph, 11 February 2023 Read full story
  20. News Article
    Nurses in England are preparing to escalate their dispute with the government by involving staff from NHS A&E departments, intensive care and cancer wards in a series of 48-hour strikes. The Royal College of Nursing (RCN) is understood to be planning to announce walk outs for two consecutive days and nights, rather than limiting action from 8am to 8pm as they have done so far. NHS leaders warned the looming strike could be the “biggest impact” on patients yet seen, with the union preparing to end a process where the RCN had agreed to exemptions with hospitals. The RCN told NHS leaders on Friday it is preparing to step up its dispute by asking its members working in emergency departments, intensive care units and oncology to join the strike. But the union, expected to announce the strike this week, will make a very limited set of provisions for the most urgent clinical situations as part of a legal obligation not to endanger life. Saffron Cordery, deputy chief executive at NHS Providers said: “A continuous 48-hour strike that includes staff from emergency departments, intensive care units and cancer care services would likely have the biggest impact on patients we’ve seen.” Read full story Source: The Independent, 12 February 2023
  21. News Article
    Children suffering mental health crises spent more than 900,000 hours in A&E in England last year seeking urgent and potentially life-saving help, NHS figures reveal. Experts said the huge amount of time under-18s with mental health issues were spending in A&E was “simply astounding” and showed that NHS services for that vulnerable age group were inadequate. Children as young as three and four years old are among those ending up in emergency departments because of mental health problems, according to data obtained by Labour. Dr Rosena Allin-Khan, the shadow mental health minister, who is also an A&E doctor, said: “With nowhere to turn, children with a mental illness are left to deteriorate and reach crisis point – at which time A&E is the only place left for them to go. Emergency departments are incredibly unsuitable settings for children in crisis, yet we’re witnessing increasingly younger children having to present to A&E in desperation.” Young people who endured long A&E waits included those with depression, psychosis and eating disorders as well as some who had self-harmed or tried to kill themselves, doctors said. Read full story Source: The Guardian, 9 February 2023
  22. News Article
    Ambulance crews reached emergencies such as heart attacks and strokes one hour quicker in January than December in England, figures show. They took 32 minutes on average, compared with more than 90 the month before. The target is 18 minutes but January's average was the quickest for 19 months. A&E waiting times also improved, with just over a quarter of patients waiting longer than four hours - down from more than a third in December. But Society for Acute Medicine president Dr Tim Cooksley said wait times remained "intolerable". And he highlighted the waits the sickest and most frail were facing for a bed on a ward. Nearly four out of every 10 patients waited over four hours on trolleys and in corridors. "The fundamental problem remains a significant shortage of workforce, leading to woefully inadequate inpatient bed and social-care capacity," Dr Cooksley added. Read full story Source: BBC News, 9 February 2023
  23. Content Article
    NHS trusts have often reported emergency department doctors having low levels of satisfaction and high rates of burnout, leading to a high turnover. In 2017, Brighton and Sussex University Hospitals (BSUH) and Western Sussex Hospitals merged to form University Hospitals Sussex NHS Foundation Trust. The Trust found that the organisation of shifts at Royal Sussex County Hospital (RSCH) and Princess Royal Hospital (PRH) and lack of flexibility were adding to the strain already felt by doctors working in the high pressure emergency department. To combat the pressure consultants and other doctors were under, the Trust implemented a system to help improve rota design and flexible working. The hope was that the system would help the trust retain and recruit staff, whilst saving locum costs and improving patient care.
  24. News Article
    Staff at the Royal London are proud of their work but don’t know how long they can continue as waiting times grow and patients suffer. Read full story (paywalled) Source: The Times, 6 February 2023
  25. News Article
    A major hospital in the UK has declared a critical incident, warning it is facing “immense pressures” on its services. Wigan’s Royal Albert Edward Infirmary urged people to avoid its A&E unless suffering a “life or limb-threatening emergency”. Wrightington, Wigan and Leigh (WWL) Teaching Hospitals NHS Foundation Trust warned that “unprecedented attendances” meant the emergency department was “full”. It said it is working with partners to discharge patients who are ready to leave hospital. The trust, which previously declared a critical incident in December, said the safety of its patients is the “top priority”. By declaring a critical incident, hospitals are able to take action so that safe services are maintained despite increasing pressures. Read full story Source: The Independent, 1 February 2023
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