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Showing results for tags 'Care coordination'.
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News Article
NHS ‘bed-blocking’ fuelled by 50 steps needed to discharge fit patients
Patient Safety Learning posted a news article in News
Hospital staff have to complete 50 separate steps on average to discharge a patient, it has emerged, as the NHS grapples with a bed-blocking crisis. On average, around 14,000 patients deemed fit to leave hospital are stuck in beds every day, according to the latest official figures. The congestion is helping to fuel the backlog in accident and emergency (A&E) departments, where more than 55,000 patients waited 12 hours or longer last month. Steve Barclay, Health Secretary, announced an additional £250 million in funding last week to buy up care beds to help discharge thousands of patients. But doctors, social care experts and families have warned discharges are being delayed by NHS “bureaucracy” and excessive form filling. Dr Matt Kneale, co-chair of the Doctors’ Association UK and a junior doctor in Manchester, said patients are held up by “numerous bottlenecks” before being sent home. “While social care shortages are the predominant issue, smaller factors stack up to create a big problem,” he told The Telegraph. Many hospitals have limits on the times their pharmacies are open, he explained, meaning patients can often be stuck on the ward all day, or an extra night, waiting for their medication. Read full story (paywalled) Source: The Telegraph, 15 January 2023 -
News ArticleVulnerable patients, including some children, have faced long delays for a suitable bed as organisations argue over whose responsibility it is to fund and deliver their care, HSJ understands. In a letter outlining winter arrangements, NHS England has warned trust leaders and commissioners against delaying emergency mental health admissions – typically needed when a patient is away from home, and understood to be more common over the Christmas period – while determining which area has which responsibility. National mental health director Claire Murdoch wrote: “It is not acceptable to delay an emergency mental health admission while determining which area has clinical and financial responsibility for the care of an individual.” She added such admissions should be arranged “as quickly as possible, and without delay caused by any financial sign-off process”. It comes as HSJ has been told patients can often end up waiting for several days in emergency departments or in “inappropriate” out of area or acute beds when disputes occur over who is responsible for their care. Read full story (paywalled) Source: HSJ, 15 December 2022
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News Article
NHSE tells trusts: ‘be robust’ with GP referrals
Patient Safety Learning posted a news article in News
An NHS England director says trusts should use ‘as robust triage as you can possibly do’ when deciding whether to accept referrals from GPs. Ian Eardley, NHSE’s joint national clinical director for elective recovery, was asked during an internal NHSE webinar how trusts can encourage GPs to work more closely with secondary care to make sure they only send appropriate referrals. He said: “There’s got to be as robust triage as you can possibly do, so if you’ve got referrals coming in which haven’t got the relevant or wrong information, then I think you need senior clinicians in a position to go back to the GP and say we need this bit of information or the other… Ultimately, it’s about robust front-end management.” However, he admitted it was a “difficult [issue and] really difficult to do anything centrally”. Read full story (paywalled) Source: HSJ, 23 November 2022 -
News Article
Hospital merger confusion blamed for cancer deaths
Patient Safety Learning posted a news article in News
A ‘leading’ cancer service has reported a series of safety incidents which contributed to patients being severely harmed or dying, HSJ has reported. An internal report at Liverpool University Hospitals Foundation Trust suggests the incidents within the pancreatic cancer specialty were partly linked to patient pathways being ill-defined following the merger of its two major hospitals. The report lists seven incidents involving severe harm or death, and five involving moderate harm. It is not clear how many of the patients died. The trust was formed in 2019 through the merger of the Royal Liverpool and Aintree acute sites, with the consolidation of clinical services an integral part of the plans. However, there were no formal plans to change the configuration of pancreatic cancer services, which already operated under a “hub and spoke” model. In one finding relevant to all 12 incidents, the report said: “Patient ownership and clinician accountability (local vs specialist) have not been defined following the merger of the legacy trusts and subsequent service reconfigurations. “This has contributed to system failures in the provision of timely quality care, particularly in patients with time-critical clinical uncertainty.” Read full story (paywalled) Source: HSJ, 5 October 2022 -
News Article
NHS 111 failures led to early Covid deaths, investigation finds
Patient Safety Learning posted a news article in News
Multiple failures by the NHS 111 telephone advice service early in the pandemic left Covid patients struggling to get care and led directly to some people dying, an investigation has found. The Healthcare Safety Investigation Branch (HSIB) looked into the help that NHS 111 gave people with Covid in the weeks before and after the UK entered its first lockdown on 23 March 2020. It identified a series of weaknesses with the helpline, including misjudgment of how seriously ill some people with Covid were, a failure to tell some people to seek urgent help, and a lack of capacity to deal with a sudden spike in calls. It also raised concerns that the government’s advice to citizens to “stay at home” to protect NHS services deterred people who needed immediate medical attention from seeking it from GPs and hospitals, sometimes with fatal consequences. Mistakes identified by HSIB included that: The CRS algorithm did not allow for the assessment of any life-threatening illness a caller had – such as obesity, cancer or lung disease – to establish whether they should undergo a clinical assessment. When many callers reached the core 111 service, there was no way to divert them as intended to the CRS, which was operationally independent of 111. Although patients who had Covid-19 symptoms as well as underlying health conditions, such as diabetes, were meant to be assessed when they spoke to the core 111 service, some were not. The number of extra calls to 111 in March 2020 meant that only half were answered. Read full story Source: The Guardian, 29 September 2022 -
News Article
County Durham and Darlington improves patient safety with AI
Patient Safety Learning posted a news article in News
County Durham and Darlington NHS Foundation Trust has created and implemented an artificial intelligence (AI) model to protect patients from acute kidney injury (AKI). The trust’s AI-driven model helps healthcare staff to identify patients who are at risk from AKI and to swiftly respond with treatment. The technology uses risk stratification digital tools that staff are able to access through an app. These are combined with care processes developed at the trust and which involve a new specialist nurse team, preventive specialist intervention, assessment and follow-up. Its implementation at County Durham and Darlington has led to a reduction in both hospital-acquired and community AKI. Overall, the incidence of AKI within the trust fell from 6.5% between March and May 2020, to 3.8% during the same period in 2021. The most significant reduction was seen in hospital-acquired AKI – which fell by more than 80%. Jeremy Cundall, medical director for County Durham and Darlington NHS Foundation Trust and executive lead for the project, said: “The partnership has resulted in patients being detected earlier – preventing AKI from occurring or mitigating the worsening of existing AKI. Accordingly, patients have been more effectively triaged to the right pathways of care including referral and transfer to tertiary renal units where appropriate.” Claire Stocks, early detection, resuscitation and mortality lead nurse for County Durham and Darlington NHS Foundation Trust, said: “This work has been a project very much about using collaborative partnerships to enhance patient safety and quality. An idea that was developed in a ‘cupboard conversation’ is now a fully operational specialist nurse service. Utilising digital innovations supports rapid triage, early detection and treatment to improve outcomes.” In addition to the improvements in patient safety, the technology has delivered cost savings for the trust too. County Durham and Darlington saved more than £2million in direct costs from reductions in AKI incidence. The improved transfer of patients has also released ICU capacity, vital at a time when the NHS is dealing with a growing national backlog for elective surgery. Read full story Source: Digital Health, 27 July 2022 -
Content ArticleFrail older adults are often at increased risk of patient safety incidents including rehospitalisation and overtreatment. In this study, published in BMC Geriatrics, researchers in the United States assessed the association of care coordination and preventable adverse events in frail older adults. Compared with non-frail older adults, they found that frail older adults reported experiencing more adverse events they believed could have been prevented with better care coordination.
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Content ArticleClinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study in the journal Australian Health Review introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation.
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News Article
Government to pick ‘integration frontrunners’ to test ‘radical new approaches’
Patient Safety Learning posted a news article in News
Government will pick five or six ‘integration frontrunner’ areas ‘to lead the way in developing and testing radical new approaches’ to speeding up discharge from acute hospitals. Along with NHS England, ministers today wrote to local NHS and council directors asking for bids to take part by 30 June. They said there was “a need to take a more fundamental look at [how the] system currently manages the discharge of patients, their post-acute care, and their access to high-quality social care”. The “discharge integration frontrunner sites” will focus on exploring “new service models, such as the delivery of a more integrated model for intermediate care across existing health and social care”, and “designing and testing new enabling arrangements, which might include new funding models, more integrated workforce models, or the deployment of new technologies”, their letter said. They said speeding up hospital discharge was “just one” potential benefit from integration and indicated that “future phases” of frontrunners may focus elsewhere. But delayed discharge has been a major pressure on the system over the past year, particularly last winter, and the letter says: “Delayed discharges are one very visible signal that the health and care system remains fragmented and too often fails to deliver joined-up services that meet people’s needs.” Read full story (paywalled) Source: HSJ, 21 June 2022 -
News ArticleHundreds of thousands of patients referred to specialists by their GPs are being rejected by hospitals and left to deteriorate because there are no appointments available. NHS waiting lists are already buckling under record-high backlogs and now delays are being compounded as local doctors struggle to even get their patients to outpatient services. Patients’ referrals are rejected by hospital trusts if there are no appointment slots available, meaning they get bounced back to the GP who is unable to help with their complex needs, leaving them without the care they desperately need. Clare Rayner, 54, from Manchester, has been left distraught by delays which have hampered the treatment she needs for complex spinal problems. She is still waiting to find out if an upcoming appointment with a neurologist is going ahead after a request for an urgent review from her GP was ignored five times. Outpatient referrals are typically classed as having an “appointment slot issue” (ASI) when no booking slot is available within a specific time frame, under the NHS e-Referral system. According to experts, the situation varies between specialities, but is reportedly particularly bad in areas such as mental health and neurology. Ms Rayner, a former medical teacher who had to retire because of ill health, said: “I’ve been sent all around the country for neurosurgery over the last few years so have been directly affected by being bounced back to my GP." “A unit in London rejected me because they said I lived too far away, which was ridiculous as they take people from all over the UK, and a local consultant just never replied to my GP’s email. Ms Rayner said she has endured “massive delays” to her care which had left her intensely frustrated. “It’s left me with significant deterioration with my spinal problems and that’s been very distressing,” she said. Helen Hughes, chief executive of charity and campaign group Patient Safety Learning, said: “NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity problems resulting in avoidable harm for patients.” A target for providers to reduce ASIs to a rate of 4% or less of their total outpatient activity was set by NHS England in 2019. Guidance in subsequent years has seen a move towards the requirement for providers to implement “innovative pathways” to support prevention of ill health. Read full story Source: iNews, 22 May 2022 Related blogs on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs A child left waiting for ‘urgent’ surgery, a blog by Clare Rayner
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Content ArticleLisa Drake, an NHS ex General Practice Manager now working in a digital advisory role, shares some of the missed opportunities for digital ways of working she witnessed when she was a patient herself.
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Content ArticleDiabetes UK are calling on government for a recovery plan to tackle 'devastating’ diabetes care delays – before it’s too late Diabetes is serious and people living with diabetes have been ‘pushed to the back of the queue’ during the coronavirus pandemic and a national recovery plan is needed to support front-line healthcare teams in getting vital services back on track. Diabetes UK warn that despite the tireless efforts of the NHS through the pandemic, many people living with the condition are still struggling to access the care they need, putting them at risk of serious complications, which can lead to premature death. This new report published by Diabetes UK as part of our Diabetes Is Serious campaign, shows the scale of the problem and sets out a series of calls to UK Government to tackle it.
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News Article
Disruption to diabetes care during Covid threatens thousands, charity warns
Patient Safety Learning posted a news article in News
Thousands of lives are being put at risk due to delays and disruption in diabetes care, according to a damning report that warns patients have been “pushed to the back of the queue” during the Covid-19 pandemic. There are 4.9 million people living with diabetes in the UK, and almost half had difficulties managing their condition last year, according to a survey of 10,000 patients by the charity Diabetes UK. More than 60% of them attributed this partly to a lack of access to healthcare, which can prevent serious illness and early mortality from the cardiovascular complications of diabetes, rising to 71% in the most deprived areas of the country. One in three had no contact with healthcare professionals about their diabetes in 2021, while one in six have still not had contact since before the pandemic, the report by the charity said. Diabetes UK said that while ministers have focused on tackling the elective surgery backlog, diabetes patients have lost out as a result, and there is now an urgent need to get services back on track before lives are “needlessly lost”. Chris Askew, the chief executive of Diabetes UK, called for a national diabetes recovery plan. “Diabetes is serious and living with it can be relentless,” he said. “If people with diabetes cannot receive the care they need, they can risk devastating, life-altering complications and, sadly, early death. “We know the NHS has worked tirelessly to keep us safe throughout the pandemic, but the impacts on care for people living with diabetes have been vast. While the UK government has been focused on cutting waiting lists for operations and other planned care, people with diabetes have been pushed to the back of the queue.” Read full story Source: The Guardian, 20 April 2022 -
Content ArticleRecovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. HSJ's Recovery Watch newsletter tracks prospects and progress. This week HSJ bureau chief and performance lead James Illman discusses virtual wards and why staffing pressures are ‘likely to be under-estimated’ and are a patient safety risk.
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News Article
A&E bookings via 111 fall ‘far short of aspiration’
Patient Safety Learning posted a news article in News
NHS England’s plan to make the 111 service a ‘primary route’ into emergency departments has fallen ‘far short of aspiration’, with only a small fraction of attendances being booked through it. NHSE began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”. Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70% of patients referred to ED by 111 services should receive a booked time slot to attend. Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected. Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking. Jacob Lant, head of policy and research at Healthwatch England, said: “Sadly, it’s clear from these figures that implementation across the country is lagging behind where we would have hoped. “Obviously this has to be seen in the context of the massive pressures on A&E departments at the moment as a result of the pandemic, but there is also a need for the NHS to really step up efforts to tell people about this new way of accessing care.” Read full story (paywalled) Source: 25 February 2022 -
News Article
Transgender teenager's death preventable, coroner says
Patient Safety Learning posted a news article in News
The death of a "vulnerable" transgender teenager who struggled to get help was preventable, a coroner has said. Daniel France, 17, was known to Cambridgeshire County Council and Cambridgeshire and Peterborough Foundation Trust (CPFT) when he took his own life on 3 April 2020. The coroner said his death showed a "dangerous gap" between services. When he died, Mr France was in the process of being transferred from children and adolescent mental health services (CAMHS) in Suffolk to adult services in Cambridgeshire. The First Response Service, which provides help for people experiencing a mental health crisis, also assessed Mr France but he had been considered not in need of urgent intervention, the coroner's report said. Cambridgeshire County Council had received two safeguarding referrals for Daniel, in October 2019 and January 2020, but had closed both. "It was accepted that the decision to close both referrals was incorrect", Mr Barlow said in his report. Mr Barlow wrote in his report, sent to both the council and CPFT: "My concern in this case is that a vulnerable young person can be known to the county council and [the] mental health trust and yet not receive the support they need pending substantive treatment." He highlighted Daniel was "repeatedly assessed as not meeting the criteria for urgent intervention" but that waiting lists for phycological therapy could mean more than a year between asking for help and being given it. "That gap between urgent and non-urgent services is potentially dangerous for a vulnerable young person, where there is a chronic risk of an impulsive act," Mr Barlow said. Read full story Source: BBC News, 25 February 2022 -
Content ArticleOn 8 April 2020 the coroner commenced an investigation into the death of Daniel France, age 17. Danny was 17 years old and was living at a YMCA hostel. He was on medication for depression and had been referred to secondary mental health services. He had made previous suicide attempts. On 3 April 2020 he took his own life. The medical cause of death was asphyxiation by hanging and the conclusion was suicide. Danny was a vulnerable teenager: he had left home and was living in hostel accommodation; he had changed his GP practice; he was trans, had changed his name and had been referred to the Gender Identity Clinic; he had recently been discharged from secondary mental health services in Suffolk and had been referred to mental health services in Cambridge; he had previously been under CAMHS and was now being referred to adult mental health services; he had diagnoses of anxiety and depression and had been prescribed medication; he had made previous suicide attempts and had long term suicidal thoughts He had been assessed by First Response Service but had been considered as not requiring urgent intervention. Safeguarding referrals about Danny were made to Cambridgeshire County Council in October 2019 and January 2020. Both referrals were closed and it was accepted that the decision to close both referrals was incorrect. In December 2019 Danny’s new GP referred him to Cambridgeshire & Peterborough NHS Foundation Trust (CPFT). He had been seen by the Primary Care Mental Health Services but was still awaiting assessment by the Adult Locality Team at the time of his death.
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Content ArticleBenjamin Lee Stroud died on the 19 March 2021 at home. He lived alone but had a partner who saw him regularly. He had a previous medical history of recreational drugs, including steroids and cannabis; he was recently diagnosed as insulin dependent diabetic and had undergone a kidney transplant. He fell and injured his back at work, and developed a dependence on pain medication, some of which were purchased on the internet. His mental health issues increased as a result of his psychical health problems. A post mortem was undertaken and the cause of death was multiple drug toxicity.
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News Article
Man's partner 'begged' for help before his death
Patient Safety Learning posted a news article in News
A man who died from a mixed medication overdose might still be alive if the help his partner was "begging" for had been provided, a coroner said. Mental health patient Benjamin Stroud, 42, had been under the care of Essex Partnership University NHS Trust (EPUT) in the weeks before his death in March. Essex coroner Michelle Brown said in a post-inquest report that, despite "escalating psychosis", his care co-ordinator did not flag the case. Following an overdose of medication in February, his partner, a nurse, called for psychiatric intervention and despite "begging" for help, Mr Stroud's care co-ordinator did not make a referral to the multi-disciplinary team (MDT). Mr Stroud died at home on 19 March and was found surrounded by empty insulin pens and pain medication. In her prevention of future deaths report, the coroner said: "It was clear from [his partner's] account that she had been begging the care co-ordinator for Mr Stroud to have an appointment with the psychiatrist, which did not occur and, from the evidence of EPUT, it was clear that Mr Stroud's care co-ordinator did not make any referral to the MDT, despite his escalating psychosis." The coroner added that the issue of care co-ordinators failing to document their reasons for not referring cases to the MDT had been raised at other inquests. "If these practices continue there is a real risk of future deaths occurring," Ms Brown warned. Paul Scott, chief executive at the trust, said: "We will continue to view all safety-related incidents as an opportunity to learn and make sure lessons are shared across the trust." Read full story Source: BBC News, 16 February 2022 -
News Article
Patients to receive better care as NHS and social care systems link up
Patient Safety Learning posted a news article in News
Patients will receive better, more joined-up care under new plans announced to improve the links between health and social care. The integration white paper sets out a vision for an integrated NHS and adult social care sector which will better serve patients and staff. Despite the best efforts of staff, the current system means that too often patients find themselves having to navigate complex and disjointed systems. Those with multiple conditions can be left feeling frustrated at having to repeatedly explain their needs to multiple people in different organisations, while others can end up facing delayed discharge because the NHS and local authorities are working to different priorities in a way that is not as joined up as it could be. The white paper sets out some of the ways health and care systems will draw on the resources and skills across the NHS and local government to better meet the needs of communities, reduce waiting lists and help level up healthcare across the country. Health and Social Care Secretary Sajid Javid said: "Better integration is vital to stop people falling into the gaps between health and social care. Ensuring our health and care systems work in unison will mean we can support hardworking staff, provide better care to patients and deliver value for the taxpayer." "Our Integration white paper is part of our wider plans to reform and recover the health and social care system, ensuring everyone gets the treatment and care they need, when and where they need it." The plans set out in the white paper will ensure care is more personalised and accessible and remove the burdens on patients. Better information sharing will mean people will no longer have to remember key facts such as dates of diagnosis or medicines prescribed, taking pressure off patients to coordinate their own care. Local health services will be tailored to the specific needs of the community to ensure the right services are available. This could mean for example more diabetes clinics in areas with higher obesity, or additional support for people to stop smoking in communities where there are higher numbers of smokers. The integration white paper is the next step in delivering the government’s promise of a health and social care system fit for the future. It builds on both the Health and Social Care Bill and the People at the Heart of Care white paper which set out a 10-year vision for social care funded through the Health and Care Levy, and follows the delivery plan for tackling the COVID-19 backlog of elective care. Dedicated plans to tackle health disparities are set to be published in due course. Read press release Source: Gov.uk, 9 February 2022 -
Content ArticleThis integration white paper sets out a vision for an integrated NHS and adult social care sector which will better serve patients and staff.
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EventuntilFrom the perspective of a service user, interactions with health and social care are often exceedingly difficult to navigate. The NHS’s traditional to approach to managing patient pathways has involved letters, appointments at set times, and stress for an individual needing to communicate that a planned consultation is no longer needed – or is needed more urgently. Knowing which service to access, and how to do so swiftly, can be particularly challenging. All this is inefficient and can lead to poor patient experience. As the service seeks to manage the backlog of care, and to meet the continuing demands of an unpredictable pandemic, that becomes particularly problematic. So how might healthcare organisations help move from patients who are passive participants in pathways to active partners, able to regularly communicate as their needs change? How might self-referrals and patient initiated follow up processes be more widely rolled out? What unpinning technology would be needed to make such a shift? This HSJ webinar, run in association with Salesforce, will bring together a small panel to discuss these issues. Register
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EventuntilIn order to support the NHS Priorities set out for 2022/2023 in delivering significantly more elective care to tackle the elective backlog and to reduce long waits, we take a look at the developing approaches to patient care using collaborations with providers delivering treatments in the home in order to support patient flow. This webinar will explore: How teams have innovated to provide hospital-at-home during the Covid-19 crisis and what’s needed to maintain the momentum of change? What is the future direction for hospital-at-home, post-pandemic, and what will accelerate or prevent adoption at scale? Evaluation and evidence required to support the case for change. Register
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Content Article
BMJ: Raining in Los Angeles (14 January 2022)
Patient Safety Learning posted an article in Blogs
Amid climbing covid case numbers and with scarce resources, Tara Vijayan describes what it has been like in the US to triage treatments that aim to prevent patients being hospitalised with COVID-19 -
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. On her admission to her local emergency department (ED) after a fall at her nursing home, Mrs E, a woman aged 93 with dementia, was booked into the ED with incorrect patient details, resulting in a new patient record being created. She was discharged that day but readmitted the next day after a second fall. She was booked into ED with the new patient record (which contained the incorrect patient details) and had an x-ray which confirmed she had a broken hip, subsequently being admitted to hospital for surgery. Mrs E had surgery the next day, during which the pathology department identified a problem with the accuracy of her patient identification information and following surgery her two sets of patient records were merged.
