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Showing results for tags 'Consultation'.
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News Article
CQC: No evidence that remote GP consultations increase A&E attendance
Patient Safety Learning posted a news article in News
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 -
News Article
How East Cheshire NHS is tackling a major cancer problem
Patient Safety Learning posted a news article in News
East Cheshire faces a serious issue with head and neck cancer, with missed target times and inefficient practices leading to worsening outcomes for patients. That’s prompted officials from the NHS Cheshire Clinical Commissioning Group (CCG) to come up with a plan of action to tackle the problem — but as Cheshire East councillors heard this week, it’s hit a snag. Since 2014, the East Cheshire NHS Trust and Manchester Foundational Trust (MFT) have co-delivered the head and neck cancer pathway. This means that patients are seen by staff at Macclesfield Hospital for diagnostic tests — and if malignant cells are detected, then the patient will be referred on to Wythenshawe for surgery or, if sadly needed, East Cheshire’s own palliative care team for supportive care. In a presentation to CEC’s health scrutiny committee, the CCG said just 10% of patients in the borough were seen at Macclesfield within the 62-day target time in Q3 of 2019/20 — against a desired level of 85%. Simon Goff, chief operating officer of East Cheshire NHS Trust, told the committee: “There is no one stop service - which is where a patient gets diagnostics all on the same day. Biopsies are not always up to the standards required so patients need to have it again. This is a key weakness in the existing service.” The lack of a ‘one stop service’ means there are no on-site pathology services — so samples are taken off-site for testing, and with biopsies needing to be analysed within 24 hours of collection, it results in 39% of all patients having to undergo the procedure again. So what did East Cheshire do about it? The first step was to launch a consultation, with 64 former patients out of roughly 300 eligible providing feedback to the Trust over the summer. The ‘robust’ consultation, saw patients express their desire to ‘know what is going on as soon as possible’, with the ‘issue of travel being outweighed by [the desire for] a quick diagnosis’. Fortunately for health chiefs in Cheshire, there are ‘outstanding’ hospitals surrounding the county — with the Care Quality Commission giving top marks to hospitals in Salford, St Helens, and The Christie in Didsbury. So with East Cheshire’s patients happy to travel a distance in order to gain a quick and accurate diagnosis, and the existing partnership with Manchester’s trust, officials are proposing moving some patients experiencing positive diagnoses and ‘bad news’ cases to MFT sites, such as The Christie or Wythenshawe Hospital. The idea is that ‘neck lump’ patients will be immediately sent to Wythenshawe, with all other patients undergoing initial tests in Macclesfield first before being either sent home with the all clear, or referred on. Biopsies will be done in Wythenshawe, as will ‘breaking bad news’ appointments — where patients are told of a positive cancer diagnosis. Officials say this solution ‘would start to address some of the clinical and performance concerns’ by cutting the average diagnosis wait time from four weeks down to one, reducing the amount of appointments patients need to attend, and allowing for continuity of care throughout treatment. Read full story Source: Knutsford Guardian, 10 October 2020 -
News ArticleMuch has been said about the delays to patient care during the first wave of COVID-19, but the full picture has been hard to pin down as statistics come in different forms and are released gradually. However, one recently-published poll performed by Ipsos Mori, with more than 2,000 UK adults aged between 18-75, revealed two-thirds of people who needed treatment for new or recently changed conditions had their care cancelled or delayed during March and July. The poll also revealed three-quarters of people missed out on routine treatment in the same timeframe. It is believed to be the hitherto largest patient-focused survey exploring the impact of the pandemic on non-COVID-19 care during its first peak. It found that – of the people who needed treatment for a new or changed condition – 23% chose to cancel their treatment while 42% had their treatment cancelled or delayed by their healthcare provider. Within the group of people requiring care for an ongoing problem, 31% of patients delayed or cancelled their treatment. Mark Davies, chief medical officer at IBM – which commissioned the poll – told HSJ the number of people with new or recently changed conditions choosing to cancel or delay their care was “really worrying”. “This survey backs up the anecdotal evidence we hear about people being worried about going into hospital during the pandemic,” he said. “It is striking that the proportion of this group of patients who did not get treatment is roughly similar to the proportion of patients requiring treatment for an ongoing health problem who cancelled or delayed their care." He said he would have expected the former group – those with new or changed conditions – to be more anxious to get treated, and warned of a “backlog of unmet need that is only going to emerge in the next few months”. Read full story (paywalled) Source: HSJ, 6 October 2020
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News Article
Has Covid changed hospitals for the better?
Patient Safety Learning posted a news article in News
The pandemic has been a catalyst for innovation in the NHS and some changes will have a lasting effect, says Dr John Wright of Bradford Royal Infirmary. The Covid pandemic has transformed our hospitals. Car parks are empty, once-bustling corridors are quiet, and these days you won't see any staff making fashion statements - we're all in scrubs and masks. Dr Wright says changes made to reduce spread of infection are here to stay and will help us live with future outbreaks of Covid and other infectious diseases. But there is also much to learn from how we have adapted to non-Covid care - with drive-through PCR swabs and blood tests, for example, or the use of oximeters to monitor oxygen levels in the blood of Covid patients in their homes, providing warning if they need to be admitted to hospital. But the biggest change has been in the way hospital consultations are carried out. Before the pandemic nearly all appointments took place face-to-face. Last year probably 90% occurred via telephone or video call, and most of my colleagues at Bradford Royal Infirmary are still running remote clinics today. This is much more convenient for patients. In the past a typical consultation might have involved a half-day of travel, the search for a parking place, and then sitting in a waiting room. However, remote consultations do have their drawbacks. Patients tend to underplay their symptoms on the phone and it is easier to avoid discussing challenging issues. Life-changing diagnoses require sensitive, face-to-face communication. Another problem is that some patients struggle with technology. The main drawback, though, is that clinicians are unable to undertake physical examination remotely. Clinical histories are the yin of the consultation but physical examinations are the yang, and video consultations only provide half the picture. Read full story Source: BBC News, 15 March 2021 -
News ArticlePatients who had longer consultations with their GP were less likely to subsequently self-refer themselves to hospital due to a worsening of their condition, a study has found. The study, which looked at factors associated with potentially missed acute deterioration, said this might be because GPs with more time to assess patients ‘are more likely to recognise deterioration and refer the patient for secondary care’. A longer consultation might also allow GPs more time to provide advice, such as telling the patient to contact the practice again if their condition worsens, the British Journal of General Practice study found. The researchers defined a potentially missed acute deterioration as a patient having a self-referred admission to hospital after being seen by a GP in the three days beforehand. They found that 116,097 patients had contacted a GP three days before an emergency admission, with patients with sepsis or urinary tract infections more likely to self-refer. GP appointment duration was associated with self-referral, with a five-minute increase in appointment time resulting in a 10% decrease on average in the odds of self-referred admissions. Patients having a telephone consultation compared with face-to-face, previous health service use, and the presence of comorbidities were all also associated with self-referred admission, according to the research. Read full story Source: Management in Practice, 2 June 2021
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Content ArticleThe COVID-19 pandemic has highlighted the need for a stronger and more inclusive health emergency preparedness, response, and resilience (HEPR) architecture. At the 150th meeting of the Executive Board in January, the Director-General committed to develop proposals, in consultation with Member States, on strengthening the architecture for HEPR, and present these to the Seventy-fifth Health Assembly. Following the Concept note published on 24 March 24, this draft white paper outlines the Director-General’s proposals for strengthening HEPR, ahead of the World Health Assembly.
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Content ArticleThis poster outlines a simple point of care risk assessment that can be carried out by healthcare professionals before each interaction with a patient.
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Content ArticleThe General Medical Council (GMC) has updated their ethical guidance on Good practice in prescribing and managing medicines and devices.
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Content ArticleThe Royal College of General Practitioners has updated its guidance on online consultations. The resource gives a useful set of questions to consider when using online consultations, such as which provider is used, the standard of patient care, and ensuring equitable access.
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Content ArticleIt is often the case that particular healthcare policies and practices change overnight from being discouraged or even forbidden to becoming more or less compulsory. An example of this is the change in how patients can access doctors during the coronavirus pandemic. At the end of July, Matt Hancock gave a speech on the future of healthcare in which he declared “… from now on, all consultations should be teleconsultations unless there is a compelling reason not to.” The following day, Sir Simon Stevens’ letter on the third phase of the NHS response to COVID-19 gave more nuanced messages and acknowledged the place of face to face consultations alongside digital and telephone consultations in some circumstances. Meanwhile, a recent RCGP survey reported that at the present time 61% of appointments are full telephone consultations and 16% are telephone triages. Many changes in how patients can access doctors have the potential to offer great benefits to patients and to ease pressures on health systems; however, what is right in some circumstances is not right for all as Ros Levenson, Chair of Academy Patient and Lay Committee, Academy of Medical Royal Colleges, discusses in her blog.
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Content Article
10 quality indicators for clinical consultation (2016)
Dr Gordon Caldwell posted an article in Clinical leadership
The process of clinical consultation defines diagnosis and is crucial to patient safety and patient outcomes However the process is frequently weak resulting in care erring off path. These indicators (taken from a paper in Postgraduate Medical Journal) could provide a way to identify weaknesses and areas for improvement.- Posted
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Content ArticleSince the rise of COVID-19 in the UK, many consultations between surgeons and patients take place remotely, via phone or video. These consultations include pre-operative assessments, discussions between surgeons and patients about the benefits and risks of their surgery, and gaining the patient’s consent to proceed with treatment. This transition to remote consultations has been central in the healthcare system’s effort to prevent transmission of COVID-19, and has required a series of adjustments by patients, hospitals and members of the surgical team. However, when it comes to the consent process, the same principles and requirements should apply as set out by the GMC and The Royal College of Surgeons of England, regardless of whether the conversation takes place face-to-face or via phone or video. In addition, during the COVID-19 period, the consent discussion should include further considerations to ensure that patients have the necessary information to make an informed decision about their treatment. This guide sets out the main principles of the consent process and provides advice on what additional information should be included in conversations with patients while COVID-19 is still prevalent in society.
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Content ArticleVirtual consultations, involving a telephone or video call between surgeon and patient, have been used in several surgical specialties prior to COVID-19. It has, however, played a particularly significant role during the current pandemic which is likely to continue in the post COVID-19 era and in future pandemic planning. This guide provides practical advice for surgeons and managers for delivering virtual consultations with surgical patients.
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Content ArticlePatient Safety Learning has submitted the attached response to the consultation for the national patient safety syllabus. The NHS Patient Safety Strategy, published in June 2019, sets out three strategic aims around Insight, Involvement and Improvement which will enable it to achieve its safety vision. It defines the Involvement aim as ‘equipping patients, staff and partners with the skills and opportunities to improve patient safety throughout the whole system’. A key action associated with this aim is the creation of a system-wide patient safety syllabus which is capable of ‘producing the best informed and safety-focused workforce in the world’. The Academy of Medical Royal Colleges (AOMRC) has been commissioned by Health Education England (HEE) to develop a new National patient safety syllabus. The Academy has now published its first version of this for review and feedback. At Patient Safety Learning, we’ve been working with the AOMRC and HEE in the initial stage of development to share our thoughts on the initial proposals in this syllabus. Now that this has been formally published for consultation, we want to share our submission as part of the consultation process which closed on Friday 28 February 2020. We welcome the development of a National patient safety syllabus and believe that it’s very important that this acts as a key driver for achieving a step change in patient safety across the NHS. In our response to the consultation we identify several areas where there are significant gaps in the initial draft that need to be addressed and comment on the development process of the syllabus, inviting a more inclusive and transparent process that enables a wide range of stakeholders to engage and contribute.
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Content ArticleNHS Digital are proposing to make changes in how private healthcare data is collected and with whom it is shared. This will involve trialling the suitability of existing NHS systems for the collection of private healthcare data and bringing it into line with the standards, processes and systems used for NHS funded care. These proposed changes are based on feedback the Acute Data Alignment Programme (ADAPt) programme has already received from a wide range of stakeholders. Wider insight from private and NHS healthcare providers, clinicians, the public and other key stakeholders is now welcomed as part of this consultation to ensure that we address any significant issues and concerns which could prevent the successful implementation of these changes. We expect this survey will take no more than 20 minutes to complete but will vary depending on the level of detail in your response.
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Content ArticleThe rapid spread of COVID-19, and the fact that healthcare facilities could be sources of contagion, has focused attention on new models of care that avoid face-to-face contact between clinician and patient. There has been particular interest in video consultations, which are already being rolled out in many countries as part of national digital health strategies. In this Editorial in the BMJ, Trisha Greenhalgh and colleagues discuss how appropriate video consultations are for dealing with the coronavirus crisis and what are the challenges of scaling up this model at speed.
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Content Article
RCOGP: Top 10 tips for COVID-19 telephone consultations
Claire Cox posted an article in Telehealth
These top tips set out by the Royal College of General Practitioners, are for clinicians conducting telephone consultations to assess and advise patients concerned they may have COVID-19 (Coronavirus). -
Content ArticleCaring for people with learning disabilities in an acute hospital setting can be challenging, especially if that patient has transitioned from children’s services to adult services. The experience in children’s acute care differs to adult acute care; this difference in processes of care can cause great anxiety for the patient and their family and carers. The reasonable adjustments that were perhaps made and sustained in children’s services may now not exist. The purpose of this blog is to demonstrate the importance for services to be designed around patients’ needs with patients, families and carers. If we get this right, the quality of care given will be improved, patient satisfaction increases and, in turn, a reduction in patient harm. It is important to note that designing services around patients is not exclusive to learning disabilities; designing services with ALL patients at the centre with their involvement is crucial for trusts to provide safe care.
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Content ArticleFinding out a patient's perspective about their care and treatment is a key part of shared decision making, but healthcare professionals do not always proactively do this in practice. This scoping review in the journal Patient Education and Counselling explored the extent to which the personal perspectives of patients are drawn out by clinicians during a consultation, as part of a shared decision making process. It reviewed studies in five databases about shared decision making. The authors found that studies reported low levels of healthcare professionals eliciting patient perspectives, The majority of content healthcare professionals and patients discussed related to physical health, with social and psychological topics mostly unaddressed.
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Content ArticleThe Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.
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Content ArticleHughes et al. studied video consulting in the NHS during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced by individual clinicians committed to innovation and quality improvement to offering what many felt was the only safe way to deliver certain types of healthcare. A new practice emerged: a co-constitution of technology and healthcare made possible by new configurations of equipment, connectivity and physical spaces. Despite heterogeneous service settings and previous experiences of video consulting, we found certain kinds of common changes had made video consulting possible. The authors used practice theory to analyse these changes, interpreting the commonalities found in our data as changes in purpose, material arrangements and a relaxing of rules about security, confidentiality and location of consultations.
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Content Article
Video consultations: A guide for practice (18 March 2020)
Patient Safety Learning posted an article in Telemedicine
Many practices are now using or considering using alternatives to face-to-face consultations because of concerns about COVID-19. Important new information and guidance is now available to support video consultations. Produced by researchers at the University of Oxford, this document is packed with extremely useful, practical advice and tips to help doctors,other primary care clinicians, and patients navigate these almost uncharted waters at a time of unprecedented challenge for the health service. -
Content ArticleFewer than 1% of UK general practice consultations occur by video. This study by Trisha Greenhalgh and colleagues aims to explain why video consultations are not more widely used in general practice.
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Content ArticleA short video to show you how to have a video consultation with your GP surgery after receiving an invitation via text message.
