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Showing results for tags 'Accident and Emergency'.
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News Article
Funding for winter clinics axed despite NHSE backing
Patient Safety Learning posted a news article in News
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- Posted
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‘Controversial’ A&E policy 'showed we're all shouldering the pain', says CEO
Patient Safety Learning posted a news article in News
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- Posted
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News Article
‘Excess deaths’ due to A&E delays rise by nearly a third in one year
Patient Safety Learning posted a news article in News
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- Posted
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News ArticleNHS 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
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News Article
NHS Wales: Thousands of hours missing from A&E figures
Patient Safety Learning posted a news article in News
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- Posted
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News Article
Rise in A&E visits for hiccups and earaches add to strain on NHS
Patient Safety Learning posted a news article in News
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- Posted
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News Article
Thousands unaware they have diabetes could be diagnosed at A&E, says study
Patient Safety Learning posted a news article in News
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- Posted
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Content ArticleOvercrowding 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.
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News Article
A&E handover delays ‘still getting worse at some hospitals’
Patient Safety Learning posted a news article in News
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- Posted
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- Handover
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Content ArticleThe 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.
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News Article
ChatGPT could help reduce A&E wait times
Patient Safety Learning posted a news article in News
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- Posted
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Content ArticleDelays 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)
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- Transfer of care
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News Article
NHS whistleblowers warn of 'unsafe' A&E staff shortages
Patient Safety Learning posted a news article in News
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- Posted
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Content ArticleThe 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.
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Content ArticleAuthors 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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News Article
Coroners issue 24 warnings over emergency care crisis
Patient_Safety_Learning posted a news article in News
Coroners have warned of increasing numbers of deaths caused by problems in the emergency pathway, with some citing ‘severe’ staffing shortages. HSJ has identified that at least 24 “prevention of future death” reports were sent to NHS organisations in England and Wales in the first half of 2023, which noted shortcomings within emergency services. In six of the 24 cases, coroners found ambulance, emergency room and other delays caused or contributed to patient deaths. Read full story Source: HSJ 1 August 2023 -
News Article
CQC names worst trusts for experience in A&E
Patient Safety Learning posted a news article in News
The Care Quality Commission has named the trusts which have performed ‘worse than expected’ on patient experience in urgent and emergency care. Data from the CQC survey of more than 36,000 people who used urgent and emergency care services in September 2022 shows a total of 10 trusts performed poorly on patients’ overall experience. Patients reported longer wait times, while only around half felt staff “definitely” did everything they could to help control their pain in the latest survey. Sean O’Kelly, the CQC’s chief inspector of healthcare, said it “remains extremely concerning that for some people care is falling short”. “These latest survey responses demonstrate how escalating demand for urgent and emergency care is both impacting on patients’ experience and increasing staff pressures to unsustainable levels." Read full story (paywalled) Source: HSJ, 26 July 2023- Posted
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- Accident and Emergency
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News Article
‘Shocking’ A&E with ‘police everywhere you look’ must be solved, says director
Patient Safety Learning posted a news article in News
A former national director has expressed her shock at visiting an accident and emergency department struggling with record numbers of mental health patients accompanied by police officers, and warned the issue needs an “absolute solution” from the area’s mental health trusts. Kathy McLean, a non-executive director at Barking, Havering, and Redbridge University Hospitals Trust, and previously NHS Improvement’s medical director, told a board meeting last week there were “police officers everywhere you looked” at the accident and emergency at King George Hospital in Ilford, which had just experienced its third consecutive record month for mental health referrals. While she recognised nearby mental health trusts North East London Foundation Trust and East London FT were “working hard”, she added: “This is not our problem, it is their problem that we’ve now got, and it’s not right for [patients], nor is it right for other people attending the emergency departments. “I’ve been to more emergency departments than most people in the country and I was shocked, everywhere you looked there was a police officer… This now needs an absolute solution. If this was ambulances sitting outside our ED, people would be saying, you’ve got to sort it.” Read full story (paywalled) Source: HSJ, 14 July 2023- Posted
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- Accident and Emergency
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News Article
Up to 900,000 older people taken to A&E each year due to lack of NHS care at home
Patient Safety Learning posted a news article in News
Almost 900,000 older people are admitted to hospital every year as an emergency because the NHS is failing to keep them healthy at home, Age UK has warned. A major lack of services outside hospitals means elderly people are also suffering avoidable harm, such as falls and urinary tract infections, the charity said. In a new report it urges NHS bosses to push through huge changes to how the “hospital-oriented” service operates and establish “home first” as the principle of where care is provided. Doing so would reduce the strain on overcrowded hospitals and leave the NHS better set up to respond to the increase in the number of over-65s and especially over-85s, Age UK said. Its report, on the state of health and care of older people in England, concluded that “our health and care system is struggling, and too often failing, to meet the needs of our growing older population.” Read full story Source: The Guardian, 11 July 2023- Posted
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- Older People (over 65)
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News ArticleA struggling trust has been warned by regulators that it could see its junior doctors removed, after concerns about clinical supervision and safety at a hospital whose A&E closes at night. NHS England inspectors who visited Cheltenham General Hospital found emergency patients – including potential surgical patients – became the responsibility of the overnight medical team when its accident and emergency closed in the evening. One night, 26 patients had been handed across, the inspectors were told, and some patients were felt to be inappropriate for medical referral. A surgical registrar could be telephoned at Gloucester Royal Hospital about surgical patients. They were told that although there were no incidents of serious harm, there had been many “near misses” and juniors felt “unsafe and unsupported in terms of consultant clinical supervision, overall clinical/nursing staffing support or logistically in managing patients in this setting or arranging transfers”. Read full story (paywalled) Source: HSJ, 7 July 2023
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BT investigated over major 999 call disruption
Patient Safety Learning posted a news article in News
An investigation has been launched into BT following the major disruption to 999 call services on Sunday. Emergency services across the country reported 999 calls were failing to connect because of a technical fault. BT, which manages the 999 phone system, apologised for the problems which were resolved by Sunday evening. The communications regulator, Ofcom, will now investigate whether BT failed to comply with its regulatory obligations. In a statement, Ofcom said its rules required BT and other providers to take "all necessary measures to ensure uninterrupted access to emergency organisations as part of any call services offered". While the incident was ongoing Cheshire Fire and Rescue Service warned of a 30-second delay to connect to 999, while Suffolk Police said its system was not working to full capacity. Read full story Source: BBC News, 28 June 2023- Posted
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Content ArticleNHS services have been under increasing pressure in recent years, particularly since the start of the Covid-19 pandemic. We have previously reported on the NHS’s efforts to tackle the backlogs in elective care and its progress with improving mental health services in England. This report gives an overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice community pharmacy 111 calls ambulance services (including 999 calls) urgent treatment centres accident and emergency (A&E) departments.
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News ArticleOne in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems. Unpublished internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in accident and emergency has almost tripled when compared to the situation before the pandemic. According to the data, the proportion of attendances by patients with a mental health problem who waited more than 12 hours in A&E before being admitted or discharged increased from 7% (34,945 breaches) in 2019-20 to 20% (88,250 breaches) in 2022-23. The situation has become so difficult, that some acute trusts are spot purchasing private sector mental health in order to discharge patients. Read full story (paywalled) Source: HSJ, 5 June 2023
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News ArticleAbout 23,000 people died in accident and emergency departments last year, according to an estimate by Labour based on Freedom of Information requests to every NHS trust in England. Half of the trusts responded to the party’s requests and, based on that information, it calculated that just over 23,000 people had died – an increase of more than 20% on 2021, and nearly 40% on 2020. The increase in deaths corresponds with a sharp rise in NHS waiting times, as hospitals struggle with high demand and a lack of resources after the Covid-19 pandemic. Wes Streeting, the shadow health secretary, said: “People turning to the NHS in an emergency should know they will be seen and treated before it’s too late. The Conservatives’ failure over 13 years to properly staff or reform the NHS has a cost in lives.” Maria Caulfield, the health minister, defended the government’s record, however, saying: “We are delivering a record number of tests, speeding up discharge from hospitals, and cutting waiting lists as we also work to halve inflation, grow the economy, reduce debt, and stop the boats.” Read full story Source: The Guardian, 19 May 2023
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'Multiple systemic failures' found at Royal Infirmary of Edinburgh A&E
Patient Safety Learning posted a news article in News
Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh. Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March. The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway. The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections. At the time of the inspection, the emergency department was on some days operating at over three times its capacity. The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. Read full story Source: The Herald, 18 May 2023- Posted
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- Organisation / service factors
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