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Content Article
Prevention of Future Deaths: Sebastian Hibberd (23 August 2019)
Sam posted an article in Coroner reports
Sebastian Hibberd, 6 years old, became ill on Saturday 10 October having developed intussusception of the bowel. He deteriorated over the weekend. His father sought medical advice on the Monday from NHS 111 and from his GP's surgery. Sebastian's condition went unrecognised as being life threatening. There were several missed opportunities for him to receive life saving treatment. Sebastian suffered a cardiac arrest and transferred to Derriford Hospital where he sadly died in the Emergency Department shortly after his arrival on the 12 October. -
Content ArticleMyla Deviren had congenital intestinal malrotation and developed a volvulus on 26 August 2015. Her mother checked the NHS Symptom finder on line and the advice was to take her to A&E but she called 111 for advice. The Health Assistant who took the call did not appreciate the significance of key symptoms due to multiplicity of symptoms described at the outset. He passed the caller on a “ warm” transfer to the Clinical Adviser whose initial reaction on hearing that the symptoms included blue lips and breathlessness was to call an ambulance, ignored her instincts and took mum through a series of digital pathways re lesser symptoms. When directly asking about the breathlessness Myla's mum put the phone close to her daughter enabling the Clinical Adviser to hear the rapid breathing herself however they did not appreciate the significance of it and did not call an ambulance. She did however pass the call to the Out Of Hours Nurse who decided that this was a case of gastroenteritis early in the call and did not appreciate the description of a child with worsening signs. Whilst the precise point at which Myla stopped breathing is not known it was sometime between when she was last seen alive approximately 06.00 and then found unresponsive at 08.00 on the 27 August 2015. She was then taken by ambulance to Peterborough City Hospital where, despite attempts at resuscitation, she did not recover a heartbeat and she died. Post mortem revealed small bowel infarction from untreated small intestinal volvulus. It is probable that with earlier transfer to hospital by ambulance and with appropriate treatment Myla would have survived.
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Content ArticleThis study from Shepard et al. aimed to explore staff perceptions of patient safety in the NHS ambulance services. The authors interviewed 44 participants from three organisational levels, including executives, managers and operational staff. They identified five dominant themes: varied interpretation of patient safety; significant patient safety risks; reporting culture shift; communication; and organisational culture. The findings demonstrated that staff perceptions of patient safety ranged widely across the three organisational levels, while they remained consistent within those levels across the participating ambulance service NHS trusts in England. The findings suggest that participants from all organisational levels perceive that the NHS ambulance services have become much safer for patients over recent years, which signifies an awareness of the historical issues and how they have been addressed. The inclusion of three distinct ambulance service NHS trusts and organisational levels provides deepened insight into the perceptions of patient safety by staff. As the responses of participants were consistent across the three NHS trusts, the identified issues may be generic and have application in other ambulance and emergency service settings, with implications for health policy on a national basis.
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Content ArticleDue to the large numbers of employees who aren’t office based and are offsite for most of their working hours, Yorkshire Ambulance Service (YAS) wanted to improve the ways they could communicate and engage with all staff, including those more dispersed. Through different approaches, YAS developed three schemes: appointed a number of employees as cultural ambassadors; procured and implemented an app called ‘Simply Do Ideas’; and established a range of staff equality networks with the aim of making sure staff from under-represented groups also had their voices heard.
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Content ArticleSean Mansell had a medical history of alcohol dependence syndrome. On the 5 July 2021, the West Midlands Ambulance Service received a 999 call at 19.23 hours from a neighbour of who reported that Shaun couldn't walk. The call was allocated a category 3 disposition which had a target response time frame of 120 minutes. An ambulance arrived on scene at 03.38 on the 6 July which was 8 hours and 15 minutes later and not within the response time frame. This was due to the fact that demand outstripped available resources. A welfare call was undertaken at 21.28 hours by a paramedic who had been asked to go into the control room to assist with welfare calls due to the high volume of 999 calls outstanding. The paramedic had not received prior training on how to complete these calls. The welfare call was conducted with the neighbour. No contact was made directly with Shaun during the 8 hour delay which led to a missed opportunity to identify a change in his condition. When the ambulance arrived, Shaun had passed away on the sofa in his front room. There was evidence of blood loss on the floor next to him and around his mouth. The police did not find any suspicious circumstances. A post mortem examination found the cause of death to be acute gastrointestinal haemorrhage and liver disease due to chronic alcoholism. The medical evidence was not able to determine if the delay in the arrival of the ambulance contributed to the death because there was no certainty of timeline about the bleeding.
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Content ArticleTherese Coffey, the new health and social care secretary, sets out the government’s plans for the NHS and social care to deliver for patients, this winter and next. The government's plan for patients sets out the priorities for health and care, delivering across four key areas: ambulances backlogs care doctors and dentists. Read her Ministerial foreword below.
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Content ArticleThis letter from NHS Confederation to Thérèse Coffey MP, the new Secretary of State for Health and Social Care, sets out what needs to be done to support the delivery of an emergency winter plan for health and social care services. It outlines the views of NHS Confederation members on what will be needed to deliver the ‘ABCD’ highlighted as priorities by the Secretary of State: ambulances, backlogs, care and doctors and dentists.
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Content ArticleLife expectancy for people with a mental illness diagnosis is 15–20 years less than those without, mainly because of poor physical health. This article in the Journal of Paramedic Practice highlights the fact that mental ill health affects a significant proportion of paramedics' patients, and argues that practitioners could assess and promote patients' physical health even though contact time is limited.
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Content ArticleThe pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
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Content ArticleThis article published by The Conversation looks at the pressures faced by ambulance services and emergency departments across Australia as a result of Covid-19. There has been an increase in 'ramping', where ambulances queue up outside hospitals. Ramping is a sign that the whole health system is under immense pressure. The article looks at the large amounts of funding Australian local governments are putting into ambulance services and emergency departments (EDs), but highlight that this will not solve the issues face by the health system if issues discharging patients into community and social care remain. It highlights a model developed in Leeds, UK, that has been adopted by the health service in Victoria, Australia, focused on solving more systemic issues. The Leeds model aims to improve patient flow in and out of the hospital and ensure that patients are quickly transferred from ambulances into EDs. Discharge coordinators organise the care patients need in the community after an ED or hospital stay. The authors also look at the role of community paramedics in keeping patients out of hospital and their potential to reduce financial and capacity pressure on health systems worldwide.
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Content ArticleIn this letter to the Secretary of State for Health and Social Care, Rachel Power, Chief Executive of the Patients Association, calls on Steve Barclay to ask the Government to develop a long-term workforce strategy for the NHS. She also requests that the government urgently fund social care and calls on Steve Barclay to take action to remedy the threat to patient safety caused by staff shortages.
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Content ArticleThis video examines the crisis facing NHS ambulance services in the UK and looks at the impact of delays and lack of capacity on patient safety. Paul Brand, UK Editor at ITV News, speaks to ambulance crews, patients and a recently bereaved family about their experiences, and highlights the increased stress levels ambulance staff are reporting. Note: The video contains footage of a 999 call that some viewers might find distressing.
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Content ArticleHow ambulance staff feel about their work has long been a concern, but the results of the latest staff survey show that their job satisfaction has deteriorated further. This blog from the Nuffield Trust takes a closer look at the findings and describes the importance of improving the situation.
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Content ArticleAmbulance services in England are under immense pressure. In July 2022, all ambulance services in England declared REAP (Resource Escalation Action Plan) level four, reflecting potential service failure. Volumes of calls to 999 are increasing, patients in distress and pain are waiting longer for help to reach them, and ambulance teams feel unable to do their job well. The new Secretary of State for Health and Social Care has previously named cutting ambulance waits as his number one priority. As he takes up the role for the second time, he will again need to include ambulances in his list of priorities for the health and care system. Steps taken to date to help address the underlying issues have not yet had an impact on the pressures facing ambulance services. This analysis from The Health Foundation looks at ambulance service performance and explores the contributing factors and priorities for improvement.
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Content ArticleThis investigation by the Healthcare Safety Investigation Branch (HSIB) explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. This is the second interim bulletin published as part of this investigation, and findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. The reference event in this investigation involves a patient who was found unconscious at home and taken to hospital by ambulance. They were then held in the ambulance at the emergency department for 3 hours and 20 minutes and during this time their condition did not improve. The patient was taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
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Content Article
AvMA case study: Lyndsey's story
Patient-Safety-Learning posted an article in Risk management and legal issues
This article tells the story of Lyndsey, who was 36 years' old and expecting her third child when she died of shock and haemorrhage, and a perforated gastric ulcer. Sadly, her baby also died as a result of Lyndsey's condition. In her narrative report, the Coroner raised concerns that Lyndsey had been prescribed methadone with no face-to-face consultation, and that she had received a prescription with no planned medical review. She also raised concerns about the reliability of the ambulance pre-alert system due the absence of systems for auditing the effectiveness and reliability of the pre-alert system and the lack of knowledge and training of staff in control. -
Content ArticleThis Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
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Content Article
I think you’re on mute… a blog by Sally Howard
Sally Howard posted an article in Culture
In her latest blog, Sally Howard talks about the importance now more than ever of listening to and looking after each other. Making your voice heard. Listening to and appreciating those around you. Looking after yourself.- Posted
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Content ArticleDue to the concerns around ambulance waiting times, the Healthcare Inspectorate Wales undertook a local review of the Welsh Ambulance Service Trust (WAST). The review explored how the risks to patients’ health, safety and wellbeing are managed whilst they are waiting for an ambulance. It assessed how patients are being managed by WAST’s three Clinical Contact Centres across Wales, from when a request for an ambulance is received to the point the ambulance arrives at the scene.
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Content ArticleHuman factors is a scientific discipline which is used to understand the interacting elements and design of a complex system, aimed at improving system performance and optimising human well-being. This book brings together a range of specialist authors to explore some of the key concepts of human factors related to the field of paramedic practice. The system elements of paramedic practice can include the patient, the paramedic and their colleagues, the environment, the equipment, the tasks, and the processes and procedures of the organisation. The relationships between these components are explored in detail through chapters which cover ‘human error’, systems thinking, human-centred design, interaction with the patient, non-technical skills of individuals and teams, well-being of the paramedic, safety culture and learning from events. This helpful and informative guide provides frontline paramedics and ambulance clinicians with practical advice and knowledge of human factors that will be helpful in supporting safe and effective practice for all involved. It will also be of interest to pre-hospital care professionals who are involved in education, learning from events, procurement and influencing safety culture. Above all, it shows how an understanding and application of human factors principles can enhance system performance and well-being, and ultimately lead to safer patient care.
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Content ArticleWhile there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care.
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Content Article
GREATix: Reporting the positive
PatientSafetyLearning Team posted an article in Safety culture programmes
The Scottish Ambulance Service has recently launched a positive reporting scheme called GREATix. GREATix is a peer-to-peer tool for recognising and learning from positive feedback in the workplace. Feedback will be used to pass on words of gratitude and identify improvement strategies. -
Content ArticleThe rate at which nursing and ambulance staff are leaving the NHS is increasing. The number of nurse vacancies has risen to over 40,000 – a record high. The ambulance service has recorded an 80% per cent increase in staff leaving the profession since 2010. These rates are unequally distributed across professions, specialties and geographical regions, introducing inevitable inequalities in patient care. This Efficiency Research project aims to use this variation to detect underlying contributory factors for better or worse nurse and ambulance staff retention, and determine its effect on patient outcomes. A research team from Staffordshire University will use their experience of applying ‘big data’ analytics and unifying large datasets from three previous studies on the effect of nurse staffing on patient safety. Projects began in 2019 and will run until December 2023.
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Content ArticleA memoir of the chaos, intensity and occasional beauty of life as a paramedic. Jake Jones has worked in the UK ambulance service for 10 years: every day, he sees a dozen of the scenes we hope to see only once in a lifetime. Can You Hear Me? - the first thing he says when he arrives on the scene - is a memoir of the chaos, intensity and occasional beauty of life on the front-lines of medicine in the UK. As well as a look into dozens of extraordinary scenes - the hoarder who won't move his collection to let his ailing father leave the house, the blood-soaked man who tries to escape from the ambulance, the life saved by a lucky crew who had been called to see someone else entirely - Can You Hear Me? is an honest examination of the strains and challenges of one of the most demanding and important jobs anyone can do.
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Content ArticleIn January 2016, a high-profile local inquest examined the death of Jasmine Lapsley, a six year old child who sadly died after choking on a grape. One of Bangors post-ACCS Clinical Fellows (not involved with the case) attended the inquest with the intention of sharing any learning points at a CPD Day for Emergency Medical Service (EMS) colleagues we were due to hold six weeks later. Upon releasing the CPD Day programme, organisers realised some EMS colleagues were profoundly uncomfortable about this talk, stating concerns such as 'talking publicly about lessons learned might upset the bereaved family'. They decided to ask all delegates at the CPD day what they thought of the inclusion of this item on the conference programme before and after the talk. This poster shows the results.
