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Found 348 results
  1. Content Article
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    What is Redthread? Redthread, a Youth Violence Intervention Programme, runs in hospital emergency departments in partnership with the major trauma network. The innovative service aims to reduce serious youth violence and has revolutionised the support available to young victims of violence. Every year thousands of young people aged 11–24 come through hospital doors as victims of assault and exploitation. It is then, at this time of crisis, that our youth workers use their unique position embedded in the emergency departments alongside clinical staff to engage these young victims. Redthreads extensive experience tells us that this moment of vulnerability, the ‘Teachable Moment’, when young people are out of their comfort zone, alienated from their peers, and often coming to terms with the effects of injury, is a time of change. In this moment many are more able than ever to question what behaviour and choices have led them to this hospital bed and, with specialist youth worker support, pursue change they haven’t felt able to before. Redthread workers focus on this moment and encourage and support young people in making healthy choices and positive plans to disrupt the cruel cycle of violence that can too easily lead to re-attendance, re-injury, and devastated communities. Redthread and the Homerton Redthread is embedded within Homerton’s A&E department. The Redthread youth work team work hand in hand with the emergency department team to safeguard young people between the ages of 11-24 who are at risk of violence or exploitation. Emergency department clinicians send referrals for at-risk young people to the Redthread team, who work on an individual basis with the young people to support them and endeavour to alleviate the risk in their environment. Redthread achieves this by liaising with statutory services such as CAMHS, Children’s Social Care and Housing to ensure that the young person is being placed first. By linking up services, Redthread ensures that the young person is the focal point and that help is being given, without duplicating existing services. Redthread works in several major trauma centres across the UK; however, the Homerton practice is the first community hospital based service. The Redthread service would not be possible without the support of the emergency department staff. Not only is the clinical and non-clinical body supportive of the service and actively referring young people, the emergency department as a whole takes an active interest in Redthread’s work – talking to Redthread staff about their work, fundraising and attending training sessions. Thanks to the initial efforts of emergency department doctors and nurses in gaining funding and support for this project at Homerton, and the continued work and collaboration by the emergency department and Redthread, the service has excellent track record after its 1 year of service. The Redthread youth workers work closely with young people in a way that clinicians do not have time to. This means that patients are cared for both medically and holistically. Though difficult to quantify results, a strong qualitative difference to the service is that there is a caring external presence within the emergency department. For young people in crisis, being seen one-to-one by someone in a non-clinical role means that there is someone solely on their side. In a lot of cases, a Redthread worker might be the first person in a long time to ask if they are ok, and to see them for who they are as opposed to the trauma that they have suffered. For the emergency department team, having a constant youth work presence acts as a reassurance that when a safeguarding issue does arise, this will be followed up and the young person will continue to be cared for. The emergency department safeguarding has improved as awareness has grown among staff members of safeguarding procedures. The Redthread collaboration has also prompted staff to be more inquisitive with the patients they see, and to consider how that patient’s behaviour may be a manifestation of underlying problems. As such, young people coming into the emergency department are safer as they are more likely to be seen and understood by clinicians, as well as receiving long term assistance as part of the emergency department care package. As the first community hospital in the Redthread network, the Homerton Redthread team have tailored and changed their service to best fit the community it serves. The team spend longer working with young people, in addition to working more closely with them than in other hospitals – taking on a constant role in our young people's lives. The breadth of presentations seen at Homerton has also resulted in a broader case-load. The result is a service which is ready to adapt to individual cases to best serve young people both in hospital and out in the community. Redthread at Homerton are also innovating and adding value structurally by meeting young people at the earliest opportunity – the statistic is that young people present to hospitals like Homerton four to five times on average before they are injured to the extent that they have to be taken to a major trauma centre. By being embedded in a local hospital such as this, we have an opportunity to engage people and help them to change their trajectories and avoid escalating harm. We’re also pioneering work around contextual safeguarding, by listening to young people and feeding back to local authorities when for example unsafe spaces in the community are identified.
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    The study notes that long-term conditions are often not recorded on administrative data and the lack of recording may be worse for weekend admissions. Studies of the weekend effect that rely on administrative data might have underestimated the health burden of patients, particularly if admitted at the weekend.
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    The Royal College of Emergency Medicine outline the actions required and call on health service leaders to encourage whole system ownership of ED performance, with every part of the hospital understanding the importance. The guide and accompanying video describes what systems should do appropriate to the performance ‘zones’ EDs find themselves in: Green (4 hour performance >95%), Amber (85-95%), or Red (<85%).
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    What will I learn? How to use the safety toolkit Designing a risk register Learning from practice Safe leadership Supporting the Second Victim Education Safety scorecard Safety culture Team working Departmental activity resources Integrating safety checklist
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    The report makes recommendations to address issues in the five areas covered by the CARES campaign. It highlights that overcrowding and challenging working conditions can result in an environment where errors are more likely to happen and makes the following recommendations to improve patient safety. Governments should: increase NHS multiyear funding to recover the healthcare service. ensure that the upcoming public inquiry examines the resilience and capacity of the urgent and emergency care system in the run up to the pandemic, as well as the performance of the system, to enable lessons to be learned for the future. ensure that there is adequate capacity for COVID-19 testing for ED staff (and their households), with short turnaround times that allow quick and safe return to work. NHS England and devolved equivalents should: ensure robust coordination of safety information produced by the new HSIB, Coroner Prevention of Future Deaths reports, NHS Resolution, National Reporting and Learning Service (NRLS), NICE, and alerts currently available on the Central Alerting System. Regulators should: regularly disseminate examples of good practice occurring in EDs to support quality improvement. use the RCEM Best Practice Guideline on ‘Infection Prevention and Control (IPC) during the Coronavirus Pandemic’ to inform inspections.
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    There are an average of 15.5 million emergency department attendances each year in England, and since 2012 there has been a 74% increase in admissions to hospital via emergency departments. The GIRFT emergency medicine report makes 17 recommendations to help match capacity to local demand and improve patient flow. You will need a FutureNHS account to view this report, or you can watch a short video summary which includes key recommendations.
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    In 2020-21, the number of people visiting the A&E department at the East Kent University Hospital Trust (EKHUFT), one of the largest trusts in the south east, increased by up to 25%. At that time, we noted a surge in cases of falls in A&E, particularly those resulting in severe harm. The risk factors were clear: A&E departments were busier than they had ever been The quality of health in patients seeking help at A&E was declining Those seeking help had longer-than-usual waiting times in A&E departments There was no clear way for staff to indicate which patients they had assessed as having a high risk of falling Falls with harm are not only devastating to patients and families, but they also have considerable financial implications for healthcare providers. For example, the estimated cost of a single fractured neck of femur (NoF) or hip is £26,000.[1] In 2020 alone, EKHUFT recorded five NoF cases in just one A&E department, representing a bill of £130,000, excluding possible litigation costs. Implementing Yellow Kits to prevent falls in A&E To try and tackle the increasing number of falls we were seeing, we decided to trial the use of yellow kits in A&E. These kits act as a visual cue for staff, helping them to quickly identify patients at risk of falling. Each yellow kit contains a small yellow fleece blanket and a pair of yellow double-tread falls prevention slipper socks. We used our FallStop four-step approach to introduce the yellow kits: Step 1: Ensure you have the support of everyone in the department and senior management It is very hard to identify effectively, at a glance, whether a patient is at risk of falling, and I am aware of how upsetting patient falls incidents can be for staff. Issues often arise at handover as it happens very quickly and information about patients most at risk of falling is often not passed on - until it’s too late. I knew A&E staff would welcome an intervention to help raise their awareness and keep them vigilant. We made sure we had the support of all A&E staff - senior management, healthcare workers, porters and housekeeping staff - which meant that as the results of the evaluation emerged, everyone involved could see the benefit and share in the success of the initiative. Step 2: Integrate visual cues into the care protocol to help staff manage patients at high risk of falling We chose blankets and socks for the yellow kits as they are items that stay with the patient throughout hospitalisation, regardless of location. They can also go home with the patient. The bright yellow colour reminds all staff that extra precautions need to be taken with particular patients, and that they should act decisively if they see these patients trying to move around unassisted or attempting to get off the trolley. The yellow kits also help ward staff during patient transfers, as each patient has already been identified as a falls risk, triggering a full fall risk assessment, in line with Trust guidelines. Step 3: Make the case for the financial impact of not taking action There is nothing more frustrating than knowing there is a simple solution that works, and being unable to implement it as others - whose support you need - just see additional costs. I needed to show the financial burden of ignoring the problem, or only addressing its symptoms, to hospital management. As mentioned, the total cost of care for a hip fracture is £26,000 and there have been five NoF fractures in our A&E during 2020. We needed to prove the effectiveness and value of visual cueing as an intervention, so we developed a single site evaluation of the intervention, with clear outcomes. The program started to develop its own momentum as we demonstrated that yellow kits could help us protect our patients and cut long-term costs at the same time. Step 4: Ensure education before, during and after the intervention To make the intervention effective, we spent time with staff in A&E, particularly in the early stages, to ensure they fully understood when to use the kits and what they mean. We ensured that all staff in the department knew which patients they should issue yellow kits to. We developed a clear protocol for issuing kits: Presenting due to a fall Acutely unwell (for example, respiratory compromised, diabetic ketoacidosis, heart problems) Patients with confusion due to dementia or delirium with any of the following features: agitation, wandering, inability to use the call bell reliably, challenging behaviour, reduced safety awareness and disorientation Likely to attempt to mobilise on their own and unsafe to do so Alcohol or drug misuse causing challenging behaviour We also ensured that staff from other departments working with A&E understood the need for extra vigilance around patients with yellow kits. Medline, the company that supplies the kits, provides educational materials such as posters for staff notice boards, storerooms and public spaces, which we used to promote the initiative. We also involved our communications team to help promote yellow kits through the staff newsletter and intranet, and even got our Chief Executive on board to promote the project through her podcast! The impact of yellow kits on falls in hospital So, did the yellow kits work? In short, 100% yes! The kits empowered A&E staff to think and work differently, and they were pleased to be part of this highly effective initiative. The trial ran for six weeks, and over this period, we lowered the number of falls by 50%. In fact, the only patients who fell were those who did not have a yellow kit. The story was the same for patients admitted to wards - not one fell in the first 24 hours, which is the period when most falls would usually happen on wards. Since the evaluation, we have continued using the kits in A&E and have also been given funding to use them in our Acute Medical Unit. I shared the results of the trial on Twitter and the yellow kits went global! There are now yellow kits being used in A&E departments up and down the UK and some trusts are trialling the scheme in their frailty units. There are also hospitals in Chile, Spain and Australia now using yellow kits. To find out more about yellow kits and the FallStop programme, follow Jayne on Twitter. Related reading East Kent Hospitals University NHS Foundation Trust's FallStop programme FallStop: Winner of the 'Professionalising patient safety' category 2019 National Audit of Inpatient Falls (NAIF) Annual report 2021 How do occupational therapists contribute to patient safety? Community thread: Red walking aids References 1 NHS Digital. October 2021
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    A cross-sectional, retrospective observational study was carried out of patients admitted from every type 1 (major) ED in England between April 2016 and March 2018. The primary outcome was death from all causes within 30 days of admission. Observed mortality was compared with expected mortality, as calculated using a logistic regression model to adjust for sex, age, deprivation, comorbidities, hour of day, month, previous ED attendances/emergency admissions and crowding in the department at the time of the attendance. The authors found that between April 2016 and March 2018, 26 738 514 people attended an ED, with 7 472 480 patients admitted relating to 5 249 891 individual patients, who constituted the study’s dataset. A total of 433 962 deaths occurred within 30 days. The overall crude 30-day mortality rate was 8.71%. A statistically significant linear increase in mortality was found from 5 hours after time of arrival at the ED up to 12 hours (when accurate data collection ceased). The greatest change in the 30-day standardised mortality ratio was an 8% increase, occurring in the patient cohort that waited in the ED for more than 6 to 8 hours from the time of arrival. The study concludes that delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30-day mortality. Between 5 and 12 hours, delays cause a predictable dose–response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.
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    The report makes the following recommendations: Putting in place more dedicated ‘High Intensity Use’ services across the country. Integrated Care Systems should develop strategies for addressing high intensity use across their areas, ensuring that there is adequate provision to meet need across acute settings, with a particular focus on areas of deprivation. Improving access to community-based support, to prevent people reaching crisis point. Investment is needed in VCSE provision linked to social prescribing and other key services, such as community mental health. Training and support should be put in place for GPs and other health professionals to identify and respond to those at risk of high intensity use. Taking action to address health inequalities and wider determinants that affect people’s health. The British Red Cross is calling on the Prime Minister to commission a national cross-government strategy to reduce health inequalities.
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    Data is included on: NHS 111 Ambulance response times Ambulance handover delays A&E waiting times Potentially preventable emergency admissions Hospital bed occupancy Violence in A&E Patients’ overall experience of NHS and social care services Mental health crisis care.
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