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News ArticleIncidents including a cardiac arrest where an ambulance took more than an hour to arrive and the patient died have prompted trust chiefs to suggest they cannot prevent patient harm under their current funding levels. A report to the North East Ambulance Service (NEAS) said patients suffering harm due to delayed ambulance response times “is a continuing theme due to the unprecedented demand the service is currently experiencing”. The report said the trust is trying to secure additional funding from commissioners, which would “reduce the likelihood of a similar incident for other patients in future”. NEAS has upheld several recent complaints made by families or patients about the harm being caused by delayed response times, but suggested the levels of demand on the service meant there was nothing it could have done differently. In one example, a woman in her 50s died from a cardiac arrest shortly after arrival to hospital after NEAS took 62 minutes to respond to a 999 call. NEAS had designated the woman, who had a history of heart attacks, a category two response – which should aim to arrive within 18 minutes on average. "All ambulance trusts have been seeing significant patient harm and the mainstream press have been strangely silent about this." "That it has got the stage where patients are routinely dying and being harmed while the resources are available, but tied up waiting outside hospitals, is truly maladministration on a grand scale." Read full story (paywalled) Source: HSJ, 9 December 2021
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News Article
Female ambulance staff subjected to ‘macho and sexualised’ culture
Patient Safety Learning posted a news article in News
A ‘macho’ culture within ambulance trusts is leading to widespread abuse of female staff. HSJ has been told of multiple cases including sexual misconduct, harassment or abuse against staff in the last two and a half years. These include: women being told that giving sexual favours would help them get on to paramedic training a woman who was told she would pass her driving course if she gave oral sex to a superior a student on placement who could not take off her jacket without comments being passed on her breasts, and therefore would wear it even on the hottest days a student given a lift by her supervisor who then proceeded to rub his hands up and down her legs during the journey. In a freedom of information request, the 10 ambulance trusts in England were asked for the number of incidents in which allegations of sexual misconduct, harassment or abuse had been made against staff. The trusts reported 221 cases since April 2019, of which at least 27 resulted in dismissal and at least 44 resulted in other disciplinary action, with some cases still under investigation. Read full story (paywalled) Source: HSJ, 7 December 2021 -
News Article
HSIB launches national investigation into ambulance delays
Patient Safety Learning posted a news article in News
The national patient safety watchdog has launched an investigation into the “significant patient harm” caused by ambulances being forced to wait with patients outside of A&E. The Health and Safety Investigation Branch (HSIB) has confirmed it intends to launch an investigation after it received several alerts expressing concerns over the issue of ambulance delays this year. The investigation comes after The Independent revealed 160,000 patients had either died or come to harm as a result of delayed ambulance response times during 2020-21, which were being driven by delays in paramedics being able to hand over patients to hospitals. The damning report, from the Association of Ambulance Chief Executives, included examples of severely ill patients not being treated properly, being forced to go to the toilet in ambulances, and being denied food and drink, as well as antibiotics and fluids. There have been multiple reports of patients dying while waiting for ambulances or while waiting outside of A&Es on the back of ambulances. In a statement to The Independent, HSIB said: “We recognise that handover delays pose a serious safety risk, potentially leading to significant patient harm and impacting on the wellbeing of NHS staff. We welcome the review by AACE as they have provided detailed insight and highlighted key safety concerns. HSIB has already received several referrals expressing similar concerns, which will be taken forward to a national investigation. We will work with AACE and others across the NHS to provide systemic safety learning to help address the challenges created by handover delays.” Read full story Source: The Independent, 2 December 2021 -
News Article
One percent of the population make up a third of ambulance call outs
Patient Safety Learning posted a news article in News
The British Red Cross have found that that 367,000 people, which equates to around one percent of the population in England attend A&E up to 346 times a year. These figures accounted for nearly one in three ambulance call outs and over one in six A&E visits. The research analysis found that a fifth of those repeatedly attending A&E lived alone and also often lived in deprived areas of the country. Frequent users also accounted for 29% of all ambulance call outs and 16% of non-minor-injury A&E visits. The data also revealed that people in their twenties were more likely to repeatedly visit A&E than any other age category. Mike Adamson, chief executive of the British Red Cross, said: 'High intensity use of A&E is closely associated with deprivation and inequalities - if you overlay a map of frequent A&E use and a map of deprivation, they're essentially the same.' Read full story Source: National Health Executive, 29 November 2021 -
Content ArticlePrehospital care is the care received by a patient from an emergency medical service before arriving at a hospital. This systematic review in the International Journal for Quality in Health and Care aimed to identify: how the prevalence and level of harm associated with patient safety incidents (PSIs) in prehospital care are assessed. the frequency of PSIs in prehospital care. the harm associated with PSIs in prehospital care.
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Content ArticleThis report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a local pilot, which has been launched to evaluate HSIB’s ability to carry out effective investigations occurring between specific hospitals and trusts. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. This investigation reviewed the case of a woman who was taken to an emergency department by ambulance in April 2021, following a 999 call from her Granddaughter to the emergency operations centre. The emergency operations centre used the wrong NHS number for the patient, which was assigned to her for the duration of her stay in hospital and led to her being offered incorrect medication.
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News Article
160,000 risk harm each year from ambulance handover delays
Patient Safety Learning posted a news article in News
Ambulance handover delays could harm 160,000 patients a year, 12,000 of them severely, according to a structured clinical review of cases by service bosses earlier this year. The Association of Ambulance Chief Executives examined a sample of 470 cases where handover to A&E was delayed for an hour or more on 4 January this year. The review, whose findings were shared with HSJ, involved every mainland ambulance service in England. It found that 85% of those who waited more than an hour suffered potential harm, with nine per cent potentially severely harmed. Extrapolated across an entire year, using levels of delays up to September 2021, this suggests 160,000 patients are potentially harmed annually. Patients who waited the longest for handover were at greatest risk of some level of harm, and the risk of severe harm more than tripled for those waiting more than four hours compared with those waiting for 60 to 90 minutes. Read full story Source: HSJ, 14 November 2021 -
News Article
Loophole in the law leaves patients at risk of abuse and sexual assault
Patient Safety Learning posted a news article in News
A loophole in the law is leaving vulnerable patients at risk of abuse and sexual assault by unregulated private ambulance staff, The Independent has revealed. While many private ambulance providers are regulated, a small number, such as those providing services at events, those providing first aid, and those who are subcontracted, fall outside the reach of the Care Quality Commission (CQC). This is due to a loophole in the legislation, which means that organisations providing healthcare at events are not required to be CQC registered. The Independent has learned that around 10,000 patients a day are seen by ambulance workers who are unregulated and not part of any registered professional body. Alan Howson, chief executive of the Independent Ambulance Association, said he was concerned about healthcare providers that “operate outside of the scope” of the care watchdog and in “plain sight and unchecked”, leaving patients at risk from staff who might “seek to misuse their power”. His concerns were in response to an internal report by the CQC, completed last year, which identified specific risks around sexual harm in relation to private providers, as well as “inconsistency” in providers’ recording of incidents. Read full story Source: The Independent, 14 November 2021 -
News Article
NHS patients dying in back of ambulances stuck outside A&E, report says
Patient Safety Learning posted a news article in News
People are dying in the back of ambulances and up to 160,000 more a year are coming to harm because they are stuck outside hospitals unable to be offloaded to A&E, a bombshell report has revealed. Patients are also dying soon after finally getting admitted to hospital after spending long periods in the back of an ambulance, while others still in their own homes are not being saved because paramedics are trapped at A&E and unable to answer 999 calls, said the report by NHS ambulance service bosses in England. In addition, about 12,000 of the 160,000 are suffering “severe harm” such as a permanent setback to their health. These include people with life-threatening health emergencies such as chest pains, sepsis, heart problems, epilepsy and COVID-19 because growing numbers of paramedics are having to wait increasingly long times to hand over a patient to A&E staff. Labour and the Liberal Democrats said the “staggering” extent of damage to patients’ health underlined the risks posed by the deepening crisis facing NHS ambulance services. The report, seen by the Guardian, has been drawn up by the Association of Ambulance Chief Executives (AACE) and is based on official NHS figures, which until now were secret. AACE represents the chief executives of England’s 10 regional ambulance services, all of which have had to declare an alert in recent months after being faced with unprecedented demands for help. It concludes that: “When very sick patients arrive at hospital and then have to wait an excessive time for handover to emergency department clinicians to receive assessment and definitive care, it is entirely predictable and almost inevitable that some level of harm will arise. “This may take the form of a deteriorating medical or physical condition, or distress and anxiety, potentially affecting the outcome for patients and definitely creating a poor patient experience.” Read full story Source: The Guardian, 14 November 2021 -
News Article
Lives at risk from 'unacceptable' ambulance waits
Patient Safety Learning posted a news article in News
Lives are at risk because patients are facing unacceptably long waits for a 999 response, paramedics across the UK have told a BBC investigation. Average waits for emergency callouts for problems such as heart attacks and strokes are taking more than twice as long as they should in England. Targets are being missed in the rest of UK too, with some seriously-ill waiting up to nine hours for an ambulance. There are numerous investigations ongoing into deaths linked to delays. The problems have forced all ambulance services to be put on their highest levels of alert - meaning patients who can make their own way to hospital are told to do so. A number of services have also brought in the military to support crews. The BBC has received reports of numerous serious incidents across the UK. Margaret Root, 82, waited nearly six hours for an ambulance to come following a stroke, and she then waited for another three hours outside hospital. When she was finally admitted, her family was told it was too late to give her the drugs needed to reverse the effects of the stroke. Her granddaughter Christina White-Smith said her grandmother had been "hugely let down". She said she did not blame the staff because they were "amazing" when they got to her grandmother, but said she is angry the NHS is not getting the help it needs. "I don't think people are aware of the severity of the situation." Read full story Source: BBC News, 11 November 2021 -
News Article
East of England Ambulance Service warns of 999 call delays
Patient Safety Learning posted a news article in News
An NHS ambulance service boss has urged 999 callers to not hang up as "there may be a delay before we pick up". The East of England Ambulance Service (EEAS) said demands on the health service meant it was extremely busy. Marcus Bailey, EEAS chief operating officer, said delays were due to a "combination" of Covid, winter pressures and recruitment. He said the service planned to recruit 100 call-handlers over the next few months to help ease pressure. The EEAS has published posters online telling emergency callers to be patient. The service covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk. Mr Bailey told BBC Look East: "It's about us warning people who are phoning 999 that it's really busy and at some points there may be a delay before we pick up the 999 call. "Remain on the line, don't hang up, and we will get to you as soon as possible." Read full story Source: BBC News, 9 November 2021 -
Content ArticleThis review by Healthcare Inspectorate Wales considers the impact of ambulance waits outside emergency departments on the overall experience of patients, which included their safety, care, privacy and dignity. It covers the period between 1 April 2020 and 31 March 2021, during the Covid-19 pandemic. The report highlights that although patients were positive about their experience with ambulance crews, handover delays are having a detrimental impact upon the ability of the healthcare system to provide responsive, safe, effective and dignified care to patients. It makes 20 recommendations for consideration by the Welsh Ambulance Services NHS Trust, health boards and the Welsh Government.
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News Article
Leak reveals hour-long ambulance delays have quadrupled in 12 months
Patient Safety Learning posted a news article in News
Ambulance handover delays lasting more than 60 minutes have increased four-fold compared to this time last year, according to internal NHS data. NHS data seen by HSJ suggests there were around 28,900 ambulance handovers lasting longer than an hour during a four-week period in October. This was almost four times higher than the 7,772 hour-long handovers recorded in October 2020. It is also significantly higher than the 17,137 seen in January 2021, which was the peak of the coronavirus pandemic. Last week NHS England wrote to trusts and integrated care systems telling them to take urgent action to “immediately stop all delays” to ambulance handovers, and that “corridor care” is “unacceptable as a solution”. Read full story (paywalled) Source: HSJ, 3 November 2021 -
News Article
Patient harm 'almost certain' due to ambulance handover delays
Patient Safety Learning posted a news article in News
Patients are being put at "catastrophic risk" of harm due to ambulance handover delays, health bosses say. West Midlands Ambulance Service (WMAS) has raised its risk rating for such delays to its highest level for the first time in its history. The risk rating shows the trust believes patient harm is "almost certain" due to the handover hold-ups. Mark Docherty, director of nursing and clinical commissioning, said it was a "completely unacceptable situation". It comes as a patient died after waiting more than five hours in the back of an ambulance in Worcestershire. At a meeting on Wednesday, the ambulance service's board of directors heard the amount of time being lost to delays had reached previously unseen levels, the Local Democracy Reporting Service said. Mr Docherty warned the situation was set to get worse over the coming months as a result of winter pressures. "Despite everything we are doing by way of mitigation, we know that patients are coming to harm as a result of delays," he said. "We know that there are patients that are having significant harm and indeed, through our review of learning from deaths, we know that sadly some patients are dying before we get to them." Read full story Source: BBC News, 28 October 2021 -
News Article
NHSE tells trusts to ‘immediately stop all ambulance handover delays’
Clive Flashman posted a news article in News
· Trusts told to identify actions to “immediately stop all delays” · Letter calls for issue to be discussed at every board meeting · It follows concern over harm to patients from delays Trusts and integrated care systems are being told by NHS England and Improvement to take urgent action to ”immediately stop all delays” to ambulance handovers, which will require “difficult choices”. A letter yesterday from NHS England’s medical director, director for emergency and elective care, and its regional directors was sent to all local chief executives and chairs yesterday. It also says they should discuss the issue of ambulance handovers at every board meeting they hold, warns that “corridor care” is “unacceptable as a solution”, and says ambulances should not be used as “additional ED cubicles”. The move comes amid signs of large numbers of very long handover delays, and concern about the risk to patients from this and the knock-on damage to ambulance response times. Read the full article here (paywalled) Original source: Health Service Journal -
News ArticleA major hospital has declared a “critical incident” after a surge in demand saw more than 100 patients awaiting treatment in A&E and 25 ambulances queueing outside. The Royal Cornwall Hospital Treliske, in Truro said “unprecedented” pressure this week is worse “than at any point during the pandemic.” It urged “families, friends and neighbours” to collect any patients who are able to “to leave hospital sooner.” Managers at Cornwall’s main hospital raised the operating level from OPEL4 — known as a ‘black alert’ — to an ‘internal critical incident’ to allow for greater cooperation to ease the crisis. It comes as the government is under intense pressure to reimpose some COVID-19 measures amid a surge in cases, with many other NHS clinics and hospitals across the country facing similar pressure. Allister Grant, medical director of the RCHT, said: “There is unprecedented demand on health and care services in Cornwall, more so this week than at any point during the pandemic. “As a result, we have escalated our operational level from OPEL4 to an internal critical incident. “Pressure will always be most visible at the Emergency Department where ambulances are waiting, and our priority here is to move people into wards as soon as we can.” Read full story Source: The Independent, 21 October 2021
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News ArticleAn NHS trust has spent more than two weeks running on emergency measures after skyrocketing demand since mid-September, while others have kept people waiting for more than a dozen hours in the backs of ambulances. The Independent has learnt one patient in the West Midlands spent 13 hours waiting to be handed over to staff at the Shrewsbury and Telford Hospitals Trust. Gloucester Hospitals Trust declared its internal incident on 19 September and only stood it down on 5 October, while London’s Barnet Hospital took similar extraordinary action on Monday due to high demand. And at North Middlesex Hospital staff saw more than 200 patients crowd into the emergency department on Monday afternoon. Declaring an internal incident is designed to activate measures that help hospitals deal with a sudden peak of demand and should only last for a short time. Such pressures are being felt across the country with NHS managers seriously concerned about what the coming months will look like as temperatures dip. One said they had not seen things as bad in more than a decade. Read full story Source: The Independent, 13 October 2021
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News Article
Ambulance handover delays at A&E are putting patients at risk
Patient Safety Learning posted a news article in News
Between April 2020 and March 2021 there were approximately 185,000 ambulance handovers to emergency departments throughout Wales. However, less than half of them (79,500) occurred within the target time of 15 minutes. During that period there were also 32,699 incidents recorded where handover delays were in excess of 60 minutes, with almost half (16,405) involving patients over the age of 65 who are more likely to be vulnerable and at risk of unnecessary harm. Data published by the Welsh Government highlighted that in December 2020 alone, a total of 11,542 hours were lost by the ambulance service due to handover delays. This figure has been rising sharply and has now reached pre-pandemic levels once again. Inspectors said these delays have consistently led to multiple ambulances waiting outside A&E departments for excessive amounts of time, unable to respond to emergencies within their communities. "These delays have serious implications on the ability of the service to provide timely responses to patients requiring urgent and life-threatening care," the report stated. Read full story Source: Wales Online, 7 October 2021 -
News Article
‘The system is broken’: Patients told to sit on chairs outside A&E
Patient Safety Learning posted a news article in News
Sick patients have been forced to wait outside a hospital A&E department on chairs and wrapped only in blankets while being treated by nurses in shocking photographs and videos captured by one worried relative. The situation, at Addenbrooke's Hospital in Cambridge, is a regular occurrence, workers have told The Independent. Footage shared with The Independent by a concerned member of the public shows one patient being cannulated, where a needle and intravenous line is inserted into a vein, while another patient has a monitor attached to track their vital signs. Patients waiting outside the A&E were said to be extremely sick, with some vomiting and complaining of worsening symptoms. “It was like something out of a horror movie,” said Maria, who has asked for her surname not to be used. “The system is completely broken from the beginning to the end..." Addenbrooke’s Hospital has been under severe pressure for months with patients queuing out the door earlier this year and patients waiting over 24 hours for a bed. One mental health patient was detained in the back of an ambulance for over 12 hours. It is just one symptom of a nationwide summer crisis in the NHS, with the military called in to support ambulance services that have reported their busiest months ever. A&E units are also witnessing record levels of attendance. Patients are being made to wait so regularly outside Addenbrooke’s A&E that heat lamps have been installed on the walls outside one entrance, used by non-Covid patients. The hospital has also built a marquee as a permanent space for waiting patients. Read full story Source: The Independent, 28 September 2021 -
News Article
Fears over NHS plan to close all local ambulance stations in London
Patient Safety Learning posted a news article in News
NHS bosses plan to shut every local ambulance station in London, prompting fears that patients could be harmed if 999 crews take longer to reach them, the Guardian can reveal. The London ambulance service (LAS) has started a controversial programme to close all 68 ambulance stations and replace them with 18 new “ambulance deployment centres” or “hubs”. A patient group has criticised the plan as “dangerous” and MPs are worried that having fewer ambulance stations around the capital could mean patients wait longer to get to hospital. “This move to shut every ambulance station in London could cause significant harm to patients because of the delays that will take place in getting to them,” said Malcolm Alexander, the chair of the LAS Patients’ Forum, a non-statutory watchdog, and Hackney Healthwatch, a government-funded statutory body that scrutinises NHS services in the east London borough. “We have come across many situations where people have suffered harm because ambulances have taken too long to get there. It looks like this is quite dangerous from the point of view of patient safety.” Read full story Source: The Guardian, 25 September 2021 -
News ArticleThe Scottish government has asked the MoD for military assistance for the country's ambulance service. Nicola Sturgeon said health services were dealing with the most challenging combination of circumstances in their history due to the COVID-19 pandemic. Opposition politicians have highlighted a series of serious ambulance delays, including one where a man died after a 40-hour wait. They said this should not be happening in Scotland in 2021. Ms Sturgeon said her government was looking at a range of plans to deal with the significant challenges facing the health services, with the detail of a request for military assistance being considered. Investigations are ongoing into several cases reported in the media on Thursday, including one where a Glasgow pensioner died after a 40-hour wait for an ambulance. The Herald newspaper reported that the family of 65-year-old Gerard Brown were told that he could have survived had help arrived sooner. Mr Brown's GP - who is said to have repeatedly warned 999 call handlers that the patient's status was critical - was quoted as describing the crisis engulfing the Scottish Ambulance Service as being like "third world medicine". The Scottish Ambulance Service is investigating the circumstances of the case, and said it will be "in contact with Mr Brown's family directly to apologise for the delay". Read full story Source: BBC News, 16 September 2021
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News Article
Increased ambulance handover delays threatening patient safety
Patient Safety Learning posted a news article in News
A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020. The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day. One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with 7% reporting the longest stay to be more than 48 hours. Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK. Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options. We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now." Read full story Source: The Royal College of Emergency Medicine, 6 September 2021 -
News ArticleThe family of a senior medic and lifelong NHS campaigner have called for an investigation into his death as it took paramedics more than half an hour to arrive at his home after operators were told he was suffering a cardiac arrest. Professor Kailash Chand, a former British Medical Association deputy chair, had complained of chest pains before one of his neighbours, a consultant anaesthetist at Manchester Royal Infirmary, called 111 for help before telling the call handler within three minutes that he believed his friend was having a cardiac arrest. “I was answering their questions when Kailash’s eyes began rolling and he slipped into unconsciousness. That’s when I said ‘this looks like a cardiac arrest’ and to upgrade the call. They kept asking questions as I started CPR and asked for an urgent ambulance. That was two or two and a half minutes into the call." Evidence seen by i News shows that it took another 30 minutes after the neighbour told the operator about the cardiac arrest for the paramedics to arrive at Professor Chand’s flat in Didsbury, Greater Manchester. National standards for ambulance trusts show that ambulance trusts must respond to category 1 calls – those that are classified as life-threatening and needing immediate intervention and/or resuscitation, such as cardiac or respiratory arrest – in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes. Read full story Source: iNews, 3 September 2021
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News Article
Private ambulance firm deregistered by CQC
Patient-Safety-Learning posted a news article in News
A private ambulance company, KFA Medical, which provided patient transport services for the NHS has been deregistered by the Care Quality Commission over concerns for patient safety. Concerns included lack of basic training and Disclosure and Barring Service checks on employees were not up to date or had not been carried out and when looking at four staff files none had current basic life support training. Sarah Dronsfield, the CQC’s head of hospital inspection, said: “We have been working with the provider since their suspension in January, however when we carried out this inspection, we found the provider had been unable to implement and sustain the necessary improvements to assure us that people were receiving safe care. This action should send a very clear message to all providers of independent health and care services that while taking enforcement action of this nature is not something we take lightly, we will always take action where appropriate to protect the health and safety of patients,” Read full story (paywalled). Source: 03 September 2021 -
News ArticleAccording to reports, a hospital in the northeast of England is having to turn away non-emergency patients from A&E due to "unrelenting" pressures on the service. This new policy was announced on Tuesday by Hull Teaching Hospitals Trust, warning patients they may need to travel up to 30 miles in order to receive care. Dr Makani Purva, chief medical officer said in a statement on the trust website on Tuesday: “Staff are working incredibly hard to provide care for patients in challenging circumstances but we need people to use the full range of services available. One in four patients who attend A&E in Hull could have been treated more appropriately elsewhere, that’s around 100 patients every day. So from today, after an initial screening process, those arriving at A&E who could safely be cared for elsewhere will be referred on to one of several alternative care centres and providers. Doing so will help us to reduce waiting times for more seriously ill patients and ensure they receive the priority care they need in hospital, while enabling those patients with non-urgent needs to receive care more quickly from a suitably skilled health professional elsewhere.” Read full story. Source: The Independent, 24 August 2021
