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Found 352 results
  1. News Article
    A 90-year-old woman waited 40 hours for an ambulance after a serious fall. Stephen Syms said his mother, from Cornwall, fell on Sunday evening and an ambulance arrived on Tuesday afternoon. She was then in the vehicle for 20 hours at the Royal Cornwall Hospital. It comes as an ambulance trust warns lives are at risk because of delays in patient handovers. It was also reported a man, 87, who fell, was left under a makeshift shelter waiting for an ambulance. South Western Ambulance Service said it was "sorry and upset" at the woman's wait for an ambulance. Mr Syms, from St Stephen, told BBC Radio Cornwall: "We are literally heartbroken to see a 90-year-old woman in such distress, waiting and not knowing if she had broken anything. "The system is totally broken." He said it took nine minutes before his 999 call was answered. "If that was a cardiac arrest, nine minutes is much too long, it's the end of somebody's life," he said. Mr Syms said paramedics were "absolutely incredible people". He added: "The system is not deteriorating, it's totally broken and needs to be urgently reviewed." Read full story Source: BBC News, 19 August 2022
  2. News Article
    Senior doctors have raised concerns about the numbers of patients now dying in their A&E department due to extreme operational pressures. HSJ has seen an internal memo sent to staff at Royal Albert Edward Infirmary in Wigan, which warns it is becoming “increasingly common” for patients to die in the accident and emergency department. The memo suggests the department has reported five deaths in the latest weekly audit, when it would normally report one or two fatalities. The memo said: “Of the 72 patients in A&E as I write this, 16 have been there over 24 hours and 34 over 12 hours. The longest stay is almost 48 hours… “It’s becoming increasingly common to die in A&E. We have included A&E deaths [in weekly audits] for the last 4 years. They used to be 1 or 2. This week there were 5. They used to die at or just after arrival, but that’s changing too… “There is every reason to think winter will be worse.” The memo echoes warnings made by numerous NHS leaders in recent months around the intense service pressures and an increased risk of incidents and mistakes. Read full story (paywalled) Source: HSJ, 17 August 2022
  3. News Article
    England’s mental health inpatient system is “running very hot” and operating well above recommended occupancy levels, HSJ has been told, as new funding to address the problem is revealed. The move was announced by NHS England mental health director Claire Murdoch in an exclusive interview with HSJ. It comes amid a steep rise in mental health patients waiting more than 12 hours in accident and emergency. Last month, an HSJ investigation revealed 12-hour waits for people in crisis had ballooned by 150% in 2022 compared to pre-pandemic levels. Problems finding specialist beds have been cited by experts as one of the root causes of A&E breaches. Ms Murdoch told HSJ the funds would not come from ”within the mental health service budget” and that they would be used to “help address any pressures where we think the answer is more of either beds or other urgent and emergency care which has a capital need.” NHSE is now working with the 42 integrated care systems to determine where the money can best be used. Ms Murdoch said the money would be spent ”where there is a particular need” and that there was “no blanket approach” to its allocation. Read full story (paywalled) Source: HSJ, 10 August 2022
  4. Event
    This is the third in a series of online lectures organised by the International Shared Decision Making Society (ISDM). This lecture will be hosted by Kristen Pecanac, UW-Madison School of Nursing. Join the webinar
  5. Event
    This face-to-face event by The Royal College of Emergency Medicine will look at research around burnout and other psychological impacts of working in the emergency department. It will feature talks from clinicians promoting staff wellbeing and explore opportunities to work with the Sustainable Working Practice Committee. View the event programme Book this event. Reduced fees are available for RCEM members and student members LMIC clinicians and students.
  6. Community Post
    During the COVID pandemic, it was clear that Emergency Departments across the UK needed to adapt and quickly, with my trust not exempt from this. We have increased capacity, increased our nursing and doctors on the shop floor, obviously with nurse in charge being responsible for all areas. We have different admission wards in terms of symptoms that the patient has, but also have a different type of flow, which i am getting my head around to be able to share I have seen departments split into 2 and various other ideas coming out from various trusts. Which got me thinking about patient safety and how well this is managed. So.... How is your department responding to the pandemic? Do you have any patient safety initiatives as a result of the response? Is there a long term plan? The reason why i am asking this, is so we can share practice and identify individual trust responses.
  7. Content Article
    For people with diabetes (PWD), hospitals can feel like unsafe places. As a result, many are afraid of having to access emergency care or stay in hospital as an inpatient. This is partly because PWD are experts at self-management, with intricate knowledge of their own bodies. I have personal experience of this, having had type 1 diabetes myself for nearly two decades. As PWD, although we can't always predict how our diabetes will behave, our decisions on how to react to every situation become instinctive. When control is taken from our hands it feels terrifying; how could anyone else make a safe decision on our behalf? It feels like handing your baby over to a stranger! Harm in hospital - a reality for people with diabetes Sadly, all too often these fears are based in reality. When appropriately trained, healthcare professionals can make safe medication decisions for PWD, but research reveals a shockingly high prevalence of harm due to diabetes-related medication and treatment errors.[2] A recent blog on the hub looked at safety concerns raised by the Healthcare Safety Investigation Branch (HSIB) about insulin administration errors in hospitals. In HSIB’s reference case, the husband of the patient in question (who was in hospital for reasons other than diabetes) had raised concerns about the potential for a dosing error on two separate occasions, but he had not been listened to by staff. As a result, the patient was given five times her prescribed dose of insulin, in what could have been a fatal incident. These concerns go back years, with various organisations including Diabetes UK highlighting the need for action to make hospitals safer for people with diabetes.[1] The Getting It Right First Time (GIRFT) report on Diabetes published in November 2020 outlined some serious patient safety issues, including the fact that many hospitals have no effective system to identify patients with diabetes and have not trained ward staff in the safe use of insulin.[2] It also highlighted inconsistent timings and content of hospital food as an issue for PWD. According to GIRFT, the risk of developing diabetic ketoacidosis (DKA)—a life-threatening complication of type 1 diabetes—is between 40-60 times higher in hospital than the background incidence rate of the type 1 population. Most people with diabetes who have stayed in hospital will have their own tale to tell about issues with the care they received. My own experience bears out this concern that many healthcare professionals simply don’t know enough about the condition to look after people with diabetes safely and respectfully. Six years ago I had a planned caesarean section and my diabetes team warned me, “Whatever happens, don’t let them take your insulin pump. They’ll try, but you keep hold of it!” As diabetes specialists, they knew that as long as I was able to, I was the best person to administer my insulin and monitor my blood sugar levels. Type 1 diabetes is a balancing act, and being put unnecessarily on a sliding scale (a glucose and insulin drip often given to PWD when they are in hospital) can damage the equilibrium we work so hard to achieve, and can cause many issues. Of course, sometimes your medical situation may mean that the best course of action is being put on a sliding scale or someone else taking over your diabetes control. But there is a tendency for doctors to see it as the safe option, when it can be unnecessary and less safe than letting an inpatient look after their own insulin needs. Unfortunately, my diabetes team was right—as soon as the anaesthetist saw my pump he was insistent he should take it from me, and I had to be incredibly assertive to be allowed to keep it on. In the end, I did keep it connected and managed excellent control throughout my three days in hospital. Despite the excellent care I received from many other healthcare professionals, the incident left me feeling on edge and like I couldn’t fully trust the staff. What people with diabetes fear most about staying in hospital It’s wrong that the very setting supposedly designed to bring us back to health is a place that seems unsafe to many people with diabetes. Wanting to better understand the issues, I recently asked the diabetes online community on Twitter why going to hospital was scary—and their responses were horrifying. I received Tweets from people in different countries, demonstrating that the problem is not confined to the NHS—people from around the world all told similar stories and raised similar concerns to people in the UK. Here are some of the issues they raised: Lack of healthcare professional knowledge about diabetes A number of people reported nurses not understanding the difference between type 1 and type 2 diabetes, with sometimes dangerous consequences. There were numerous reports of people with type 1 diabetes being denied insulin. One person said they had been denied insulin because they were over 50 and it was assumed they “must have type 2.” Another person described how an A&E consultant did not realise they needed insulin all the time, and refused to administer any more once they were out of DKA. This resulted in them going back into DKA and needing further treatment which could have been avoided with the right knowledge. Many PWD talked about the fact that healthcare professionals in inpatient settings did not know anything about how insulin pumps and continuous glucose monitors (CGM) worked. Some had never even seen them before. With these devices becoming more and more common in the UK, it seems important that all healthcare professionals are trained to understand what they are, and the basics of how they work. No one would expect an intricate knowledge of how they work, but being able to recognise them, knowing where to look for more information and seeking to facilitate their use in inpatient settings would be a good start. Treating hypoglycaemia (low blood sugar) in hospital was also described by many as being very difficult. One person said, “I told them on a few occasions I felt ‘low’. Finally Lucozade got wheeled out but it was almost an inconvenience.” Having diabetes technology and equipment taken away Many PWD reported a fear of devices amongst medical professionals, describing how their monitors and pumps were taken and “locked away.” In one particularly worrying account, someone described being sedated when they protested against having their pump taken away. Many people described intense fear and the feeling of having all power taken away from them as a patient when their devices were removed. Healthcare professionals not listening to or trusting people with diabetes Most people were understanding that healthcare professionals can’t be expected to know everything about diabetes. However, the most commonly expressed frustration was about not being listened to when sharing information about their diabetes. This is the issue that was raised in the HSIB investigation. There was a perception that some healthcare professionals are “arrogant” and assume their knowledge is superior to that of their patient. Some people reported receiving sarcastic and disparaging remarks from healthcare professionals, which heightened their sense of being unsafe. One person said, “It’s dead hard to have to fight your corner while feeling so unwell.” Another person who had type 1 for many years reported being ‘diagnosed with type 1’ while in hospital, despite repeatedly telling staff she already had the condition. Lack of systems to support safety There were numerous reports of insulin drips running out and people being left without any insulin for hours. The reason often given for this was that no doctor was available to sign off the prescription. People also reported a lack of checks in places, for example, in nurse administration of insulin via a sliding scale. One person said, “The nurse left the glucose drip on but turned off the insulin. It terrifies me to think how bad this could have been.” One person reported a fellow patient having to fetch a nurse from the nurses station because no one was responding to their call button when they needed hypo treatment. This kind of scenario is doubtless linked to NHS staffing shortages that are currently causing many safety issues for staff and patients. Alongside these horror stories, I did come across examples of good practice which left PWD feeling confident that the care they were receiving was safe. One Twitter user described being able to keep her pump and continuous glucose monitor on during brain surgery, and was told by the medical team looking after her, “You are the expert on your condition, you advise us.” Another said, “In recent years [I have] been really impressed with how all staff just leave me to my own devices.” Another said that, “most HCP listened to me as T1 myself and welcomed my input.” However, most of these positive experiences were qualified with a ‘but’ followed by a story of a negative or dangerous experience of emergency or inpatient care. You can read more of the comments I received from PWD in this community thread on the hub. Improving safety: policy, training and staff attitudes This lack of consistency across services is a major problem—we can never plan where or when we will need hospital treatment, so it is important that issues are addressed across all trusts and settings. The GIRFT report highlights this issue, recognising that “there is still a large degree of variation in the quality and availability of targeted inpatient services, and in the frequency of hospital-acquired harm resulting from poor diabetes care.”[2] The National Diabetes Inpatient Audit (NaDIA) has been carried out across 81% hospitals over the past few years and is a useful tool in providing data to help specialities and trusts identify and overcome diabetes-related safety issues. For example, its 2021 report highlighted an increased prevalence of DKA among patients in surgical specialties and recommended “the establishment of processes to ensure that insulin is not stopped in people with type 1 diabetes.”[3] The information provided by NaDIA and the GIRFT recommendations are good steps forward, but whether services will have the resources and capacity to take action, is another question. People with diabetes tend to be great educators on the condition they live with, and some reported using their hospital stay as an opportunity to educate healthcare professionals looking after them about diabetes. But it shouldn’t be down to them. Diabetes is a complex condition that requires attention to detail and accurate knowledge to manage safely. Not everyone can be an expert, but helping staff identify when to ask for help from someone who is—and having the humility to do it—should be a priority. The GIRFT report observed that having an increased presence of diabetes specialists in inpatient settings can hugely reduce the number of diabetes medication errors. It recommends the presence of a seven-day multidisciplinary diabetes inpatient team in every hospital to ensure appropriate planning and support for patients with diabetes, whatever they are in hospital for.[2] Perhaps most importantly, hospital staff need to be trained to ask people with diabetes about their management and have a degree of trust in their judgement. Only then will PWD feel confident about going to hospital, whether in an emergency or for elective treatment—shared decision making shouldn’t stop at the hospital door. References 1 Making hospitals safe for people with diabetes. Diabetes UK, 2017 2 Rayman G, Kar, P. Diabetes GIRFT Programme National Specialty Report. NHS England & NHS Improvement. November 2020 3 National Diabetes Inpatient Audit (NaDIA) Harms 2020, England. Healthcare Quality Improvement Partnership. 2021
  8. Content Article
    Key points May’s data show that pressure on the system remains steady. Despite sustained volume of the most serious incidents, there were improvements in call answering and response times – although the latter continue to exceed national standards by some margin. Patient handover delays remain very high, with many thousands of patients waiting three hours or more, increasing their risk of harm and resulting in a significant impact on resources. The volume of 999 calls dropped for the second consecutive month, but remain well above the series average. 999 calls answered in the most recent 12 months exceeds the previous period by more than 2 million. Call answer time decreased for the second month since March but remains more than twice that seen the same time last year. Call answer delays of 2 minutes or more spiked at the end of May. Volume of Category 1 and 2 incidents remain significantly higher the same month last year. Annualised data show much higher volumes for the most recent 12 months, compared with the previous period. C1 continues to account for more than 10% of all incidents (compared with 7% in 2020). Meanwhile C4 incidents continue to shrink, accounting for 0.7% of incidents in May 2022 compared with 2.6% in May 2019. Response times for all incidents continue to exceed national standards, but in every category the time taken to respond decreased in May 2022. Nonetheless, mean response times have now exceeded the national standard for over 12 months for C1 incidents, and nearly 2 years for C2 incidents. Transport to Emergency Departments increased in May 2022. However, volume remained below the series average with the year-on-year trend showing a steady decrease. Conversely, Hear and Treat incidents continue to increase steadily. Despite a second month of contraction, the number of longer patient handover delays remain some of the highest seen to date. The longest delay across the month was just under 24 hours, while 387 patient handovers took 10 hours or longer
  9. Content Article
    Coroner's concerns The NHS 111 telephone triage service uses the NHS Pathways computer system to triage patients via pre-determined question/answer based algorithms. The pre-determined questions are the same whether the caller is an adult or a child. Alex struggled to comprehend some of the medical terminology used during these calls. Call handlers are not permitted to deviate from the prescribed wording of the pre-determined questions, and this created confusion and inconsistency in the patient’s answers. Consideration should be given as to how young and/or vulnerable patients can be assisted to provide accurate information about their symptoms. The NHS Pathways algorithm for triaging vomiting and diarrhoea symptoms is unclear as patients may fail to understand what is meant by ‘soil’ or ‘coffee ground’ vomit. Consideration should be given to how this important diagnostic feature can be explored during telephone triage, especially when the patient is young and/or vulnerable. The NHS 111 telephone triage service provides an electronic copy of the patient triage notes to the patient’s GP within minutes of the call ending. There was a delay of 7 days in the GP surgery uploading the 111 triage document to Alex’s patient record. This prevented Alex’s GP from reviewing the triage note prior to his consultation with the patient. There is no guidance as to expected practise with regards to the timely updating of electronic patient records, and as a result delays are all too frequent. Adults presenting to their GP or Emergency Department with abdominal symptoms receive a lipase and/or amylase blood test as part of the standard package of blood testing. The levels of each of these enzymes can be used to diagnose pancreatitis. Patients under the age of 18 years are not offered this testing as standard, on the basis that pancreatitis is rare in paediatric patients. The coroner heard anecdotal evidence of some doctors at Kingsmill Hospital now add this test to the standard admission bloods for older teenage patients who present with non-specific abdominal symptoms but the NICE guidance (September 2018) is not explicit in this regard. Consideration ought to be given to a national approach for lipase/amylase testing in young people with relevant symptoms. Patients who make an unscheduled return to the Emergency Department within 72 hours of discharge are required to have a review undertaken by an ED Consultant, or a ST4 trainee or above in the absence of a Consultant on the ‘shop floor’: RCEM Guidance June 2016. Some hospitals will admit returning paediatric patients for observations but practise seems to vary doctor-to-doctor and across Trusts. Consideration ought to be given to a national approach.
  10. Content Article
    The authors found that the four most frequent tracheostomy-related complications were: unplanned decannulations, 71.4% uncontrolled bleeding/hemorrhage, 9.2% partial/total occlusion, 6.9% mucus plug/thick secretions, 6.9%. They concluded that in order to manage patient airways safely, staff need to be knowledgeable, confident and equipped with appropriate skills and equipment to respond promptly when there are complications. They discuss potential safety strategies to reduce the risk of complications and issues related to equipment, knowledge and communication.
  11. News Article
    The chief executive of a small acute trust has described the “terrifying situation” faced by ambulance crews and hospital staff in trying to provide adequate emergency care as coronavirus threatens to overwhelm the local NHS services. Susan Gilby, of Countess of Chester Hospital Foundation Trust, told HSJ staff are seeing “tragic and potentially avoidable” instances where patients with COVID-19 have reached the emergency department too late. She suggested this is due to a combination of patients waiting too long to call 999, and then having to wait long periods for an ambulance to arrive. Cheshire has been among the hardest hit areas in England during this third wave of coronavirus, with all four of its acute hospitals having very high covid occupancy rates. Dr Gilby, a former critical care consultant, said her trust has been at around 60 per cent covid occupancy for the last fortnight, which has made her increasingly fearful of the difficulties in admitting patients through the emergency department due to a lack of beds. This can then cause knock-on delays for patients arriving in ambulances, and ties those ambulance crews up for long periods, preventing them from responding to further 999 calls. She said ambulance turnaround times had been relatively good at the Countess of Chester, but she had spoken to paramedics handing over patients who were “really struggling” to get to people quickly enough. Read full story (paywalled) Source: HSJ, 22 January 2021
  12. News Article
    Patients calling NHS 111 in London could face a 30-hour wait before being admitted to a hospital bed, the capital’s ambulance service has warned. Slides presented by London Ambulance Service Trust at a webinar with NHS London this week showed “category three” patients faced long delays at all stages of the process. The length of each stage was said to be as follows: having calls answered at 111 centres (20 mins); the “revalidation” of the call before it is passed to 999 (two hours); 10 to 12 hour waits for an ambulance; and similar waits in emergency departments before being admitted to a bed. Category three calls are considered urgent, but not immediately life-threatening. The calls could involve abdominal pain, uncomplicated diabetic issues and some falls. Category three patients are among those the NHS is encouraging to call first, rather than going straight to accident and emergency, as part of the flagship “111 first” drive designed to produce pressure on emergency care. Normally, the pathway from a 111 call being made to a patient being admitted to a bed would take nine hours with a faster response at all stages, the slides suggest. But the pressure across the NHS from covid cases is leading to much longer waits. Read full story (paywalled) Source: HSJ, 8 January 2021
  13. News Article
    London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
  14. News Article
    Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in COVID-19 admissions combined with limited capacity, according to figures leaked to HSJ. Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed. It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity — combines with potential additional winter demand in coming weeks. Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more. Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one. And another reason behind delays is waiting for covid test results before admitting patients. Read full story (paywalled) Source: HSJ, 4 January 2021
  15. News Article
    An ambulance crew had to wait seven hours to hand over a patient in the West Midlands, it has been revealed. The case on 11 December was highlighted in the West Midlands Ambulance Service's in-house magazine, which said average waits had "ballooned". It said average waits at one hospital were running at nearly three hours in early December. The ambulance service said it hoped to put another 40 crews on the road by January. Delays in hospitals taking over care of patients is considered "risky", NHS England said, because it not only delayed patients receiving specialist assessment and treatment, but also reduced the number of ambulances available to respond to emergencies. The West Midlands trust's weekly briefing magazine, published on 17 December, said only the East of England trust had experienced a similar level of "horrendous" delays. It added that another four hospitals in the West Midlands had average delays of about two hours. The "knock-on" effect it said was some high-risk patients were waiting longer for an ambulance than they should. Meanwhile, some staff had to work late beyond their shifts and missed meal breaks. Read full story Source: BBC News, 23 December 2020
  16. News Article
    Acutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned. GPs have reported receiving inappropriate NHS 111 referrals including: an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke; a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice. From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices. Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots. The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’. GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care. One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP." Read full story Source: Pulse, 21 December 2020
  17. News Article
    The increase in the number of remote GP consultations during the COVID-19 pandemic has not appeared to increase A&E attendances, according to the Care Quality Commission (CQC). The regulatory body discussed concerns about access to GP services during its September meeting, including the suggestion that the increase in remote consultations and a perceived lack of face-to-face appointments were potentially leading to ‘increased attendance at A&E’. However, chief inspector Rosie Benneyworth has confirmed that – having looked into this – the organisation has ‘not seen evidence’ to suggest a link between the two. Despite this, she noted ‘anecdotal concern’ about people attending A&E departments if they ‘feel their needs are not being met elsewhere’. GPs have faced media criticism in the past few months for the perception that they have are failing to provide face-to-face appointments, with some believing that patients attend A&E as a result. Minutes from the September CQC board meeting said: ‘Concerns about access to GP services were… discussed, including the suggestion that digital appointments were not meeting the needs of some patients and how this could potentially lead to increased attendance at A&E. Work to quantify the extent of the problem and to monitor it was underway.’ But Dr Benneyworth told Pulse this week: ‘While there may be some anecdotal concern about people attending Emergency Department (ED) if they feel their needs are not being met elsewhere, we have not seen evidence to suggest a link between digital appointments and ED attendance. The latest figures also show there has not been a sharp rise in online/video appointments (according to NHS Digital they are not currently at pre-COVID-19 levels). Read full story Source: Pulse, 7 December 2020
  18. News Article
    Emergency medics are writing to hospital chief executives warning them that some trusts are being ‘complacent’ about crowding in A&E, they have told HSJ. The Royal College of Emergency Medicine (RCEM) is sending a letter to trust chiefs today calling on them to urgently plan for how they will stop corridor waits and exit blocking ahead of January and February, typically the busiest months. It says some trusts were not treating emergency department crowding as a “high priority”, despite covid risks and pressures. It is also calling for overcrowding in the emergency department (ED) to be classed as a “never event” — a set of major safety risks. RCEM’s concern comes amid apprehension over long ambulance queues at hospitals across the UK, and difficulties enabling social distancing between patients in many EDs. Read full story (paywalled) Source: HSJ, 3 November 2020
  19. News Article
    The Care Quality Commission (CQC) has criticised a new trust’s leadership after issuing it with a warning notice to improve care in its two emergency departments. The watchdog warned North Cumbria Integrated Care Foundation Trust that patients were not always receiving timely and appropriate care, while delayed transfers of care had “resulted in significant delays in admitting patients on to wards”. The CQC — which carried out focused inspections at the trust in August and September after concerns were raised about risks to patient and staff safety — added there was evidence of “insufficient numbers of suitably qualified, skilled, competent and experienced clinical staff”. The CQC also said there was a lack of an effective system to mitigate risks, including infection control in the emergency department escalation areas and on some medical wards. Of the trust’s Cumberland Infirmary and West Cumberland hospitals, the CQC said: “People could not access the urgent and emergency care and medicine service when they needed them and often had long waits for treatment.” The CQC’s inspection report, published today, also said the trust had an “inexperienced leadership team” which “did not always have the necessary skills and abilities to lead effectively”. It added there were “few examples of leaders making a demonstrable impact on the quality or sustainability of services”. Read full story (paywalled) Source: HSJ, 30 November 2020
  20. News Article
    Emergency care leaders are warning it will take up to six more months to determine whether pilots of a radical change to accident and emergency are working, even though it is due to go live nationally next week, HSJ has learned. HSJ understands the new “111 First” system — where walk-in patients not in medical emergencies call 111 to “book” urgent care — is set to “go live” across England from next week following pilots in acute trusts which have been run since the summer. From 1 December, people will be able to call NHS 111 from anywhere in the country and have urgent care “booked” for them if needed, it is understood. NHS England has been pursuing the 111 First model to help reduce overcrowding and the risk of nosocomial infections in A&Es. The service is also intended to be able to book them into GP practice appointments. Well-placed sources confirmed most acute trusts have now implemented some form of 111 First and the model is set to be part of their standard operations when the national system “goes live” next week. A national advertising campaign is expected to promote the approach. But the Royal College of Emergency Care Medicine said there was a “vocal minority” of clinicians who are “vehemently against” 111 First as they believe it will increase demand in emergency departments. Read full story (paywalled) Source: HSJ, 25 November 2020