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Content ArticleAs we seek to develop a national healthcare system that delivers true 21st century care, we are confronted by a COVID-19 pandemic that has identified numerous challenges. Among the most important: the need to provide correct diagnoses. Definitive answers about diagnosis are critical not only for patients, but also for their families and others around them. Consequential questions gnaw at us: Are we diagnosing COVID-19 correctly? Are we missing cases? How do we know? How can we improve? Gopal Khanna and Jeff Brady are hopeful that some of the changes that have resulted from the US's battle against the pandemic will spark the long-term improvements in diagnostic safety that will strengthen the system’s ability to address COVID-19 and other challenges we face.
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Content ArticleThere are large numbers of patients with olfactory disturbance in the UK and shortfalls in assessment and support amongst mainstream practice in both primary and secondary care leading to significant quality‐of‐life impairment and potential missed diagnoses. The aim of this study from Erskine and Philpott was to determine the key themes which can be identified from the accounts of anosmia sufferers and to identify important areas to target for future research or service development.
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Content ArticleThe need for radical investment and reform of diagnostic services was recognised at the time the NHS Long Term Plan was published in 2019. This report, commissioned by NHS England at that time, alongside a review of adult screening services, was nearing publication before the COVID-19 pandemic struck. However, while the recommendations made pre-pandemic still stand, additional actions will be needed to deliver safe, high quality diagnostic services in an endemic phase of the disease and to support the recovery of diagnostic services.
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Content ArticleDiagnostic delays for endometriosis can occur as many of the symptoms are very similar to other common medical conditions. During 2018 and 2019, there were 24 incidents reported to the MDU (a medical defence organisation) which involved endometriosis. A common factor in these incidents involved a complaint or claim following an allegation of a missed or delayed diagnosis. A delayed diagnosis can lead to prolonged pain and suffering and may cause other physical and psychological problems for the patient, such as infertility, anxiety and depression. Failure to diagnose endometriosis or a delay in diagnosis is not necessarily negligent, but a claimant may have a case if they can demonstrate that a doctor's management fell below the expected standard - for example, by not adequately examining the patient, or by not considering the diagnosis when a patient presents with those signs and symptoms as described in the NICE guidance. MDU offers advice in this blog to help reduce the risk of a delayed or missed diagnosis of endometriosis.
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Content ArticleDisparities in healthcare exist because of socioeconomic factors, structural racism and implicit bias. The panelists in this video identify the problems and discuss what solutions are in place that could improve health disparities such as medical education, more training for underrepresented minority physicians, more funding for research, and fast-tracking publication of research. Furthermore, the panelists explore how the field of dermatology and other medical specialties can address these issues.
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Content ArticleThis NHS Resolution video looks at three diseases where GPs often miss the diagnostic signs resulting in late referrals: cauda equina, colorectal cancer and subarachnoid haemorrhage. Clinical symptoms to be aware of in these diseases are highlighted.
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Content ArticleThe US National Quality Forum (NQF) convened a multistakeholder committee to identify recommendations for the practical application of the Diagnostic Process and Outcomes domain of the 2017 Diagnostic Quality and Safety Measurement Framework, measuring and reducing diagnostic error, and measuring and improving patient safety. This report outlines the recommendations through a series of four Use Cases – missed subtle clinical findings (Use Case 1), communication failures (Use Case 2), information overload (Use Case 3), and dismissed patients (Use Case 4) – that depict resolutions to specific types of diagnostic errors, and broad-scope, comprehensive recommendations with applications to multiple populations and settings.
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Content Article
Illuminating the rare reality (28 February 2019)
Patient Safety Learning posted an article in Rare diseases
This report is a culmination of findings from Rare Disease UK and Genetic Alliance UK to evidence the experiences of those living with a rare condition. The report underpins their call for a refresh and review of the UK Strategy for Rare Diseases focussing on five key areas: diagnosis, rare disease care and treatment, information and support, rare disease research and keeping the strategy up to date. -
EventuntilNCRI Virtual Showcase will feature a number of topical sessions, panel discussions and proffered paper presentations covering the latest discoveries across: Big data and AI Prevention and early detection Immunology and immunotherapy Living with and beyond cancer Cancer research and COVID-19 Further information and registration
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EventuntilAre you a patient who has been waiting to receive a diagnosis or test results during the last six months? This includes, but is not limited to, CT scans, MRI scans, and endoscopy and dermatology procedures. Has the COVID-19 pandemic affected your service? Would you like to help to improve the patient experience of waiting for a diagnosis? The Patients Association is holding an online Zoom patient group discussion on this topic on Tuesday 27th October, 2.00-4.00pm, and we are seeking patients to take part. An £80 incentive payment will be offered in Amazon vouchers and places are limited. Participants will be chosen on the basis of suitability to ensure the group is representative of a wide variety of backgrounds and experiences. Please fill in the registration form https://www.surveymonkey.co.uk/r/CRNMC2T if you are interested.
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Content ArticleThe purpose of this Royal College of Nursing (RCN) document is to provide standards and sample assessment tools for training in genital examination in women for registered nurses working in sexual and reproductive health settings, and related health and social care settings. It is envisaged that this document could be used by registered health care professionals who would require training in genital examination in order, for example, to undertake the following procedures: cervical sampling including liquid based cytology and colposcopy taking swabs as part of a sexual health examination inserting, checking or removing intrauterine devices and IUS vaginal ultrasound hysteroscopy nurses working within early pregnancy and acute gynaecology settings and as part of any extended role in history taking and examination for the assessment of symptomatic women.
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Content Article
Alexa, do I have COVID-19? (30 September 2020)
lzipperer posted an article in Other health and care software
This article in Nature explores how voice activation technologies have potential to diagnose coronavirus infections, dementia and depression. Emily Anthes discusses efforts around the globe to reach the highly anticipated potential of this technology in healthcare. -
Content ArticleConsumer-focused digital healthcare apps are widely used for health maintenance. This scoping review from Millenson et al. examined evidence on interactive direct-to-consumer diagnostic applications and found a lack of robustness on evaluation methods.
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News Article
Lockdown patients ‘put off’ GP visits after warnings about restricted care
Patient Safety Learning posted a news article in News
GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said. The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”. Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital. Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.” Read full story (paywalled) Source: The Times, 16 October 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 ArticlePeople awaiting a CT or MRI scan will be able to have one on the high street under NHS plans to improve access to diagnostic tests. NHS England plans to set up a network of new “one-stop shops” where patients will be able to have scans closer to home rather than having to go hospital. They are intended to reduce the risk of patients getting COVID-19 in hospital and speed up the time it takes to undergo diagnostic testing by having more capacity. NHS England’s governing board approved a plan on Thursday by Prof Sir Mike Richards to create “community diagnostic hubs across the country over the next few years”. It is part of a planned “radical overhaul” in the way patients access a range of diagnostic tests, screening appointments and other services. The hubs, which would open six days a week, may also perform blood tests, lung function checks and endoscopies, in which a camera is put down the throat. The new facilities would be sited in disused shops or in shopping centres. They are part of the NHS’s drive to make it easier for people to be tested without having to go to hospital, amid concern that reluctance to do so is part of the reason fewer people are undergoing cancer screening. It is already undertaking lung cancer tests in 10 mobile centres that are parked at supermarkets and shopping centres. Bigger hubs could also offer mammograms, eye health checks, scans for pregnant women, hearing tests and gynaecological services. Hospital bosses welcomed the plan, which they said should reduce waiting times. Miriam Deakin, the director of policy and strategy at NHS Providers, which represents NHS trusts, said: “Doing these checks in the community rather than in hospital could support trusts as they grapple with a second wave of Covid-19, winter pressures and tackling backlogs of care.” Read full story Source: The Guardian, 1 October 2020
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News Article
Leaked data gives first view of growing cancer waiting list post covid peak
Patient Safety Learning posted a news article in News
Official data from mid-September shows that nearly 6,400 people had waited more than 100 days following a referral to cancer services. The leaked data reveals for the first time the length of the cancer waiting list in the wake of the first pandemic peak, during which much diagnostic and elective cancer care was paused. The list consists of those waiting for a test, the outcome of a test, or for treatment. NHS England and Improvement only publish waiting times for patients who have been treated – not the number still waiting – so this information has been secret. The data, obtained from official emails seen by HSJ, showed the total number of people on the cancer waiting list grew substantially, from 50,000 to around 58,000, between the start of August and the middle of September. Of the 6,400 people recorded to be waiting more than 104 days on 13 September, 472 had a “decision to treat classification”, meaning they have cancer and are awaiting treatment. NHS England has said reducing the cancer waiting list would be overseen by a national “taskforce”, which is being chaired by national director for cancer Peter Johnson. Experts have warned the delays already stored up in the system could cost tens of thousands of lives as patients go undiagnosed or have their diagnosis and treatment later than they otherwise would. HSJ asked NHS England if harm reviews had been carried out for those on the waiting list and whether it had discovered if those waiting longer than104 days had been harmed, but did not receive an answer. Read full story (paywalled) Source: HSJ, 29 September 2020 -
Content ArticleMyalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is characterised by persistent and disabling fatigue, exercise intolerance, cognitive difficulty, and musculoskeletal/joint pain. Post-exertional malaise is a worsening of these symptoms after a physical or mental exertion and is considered a central feature of the illness. Scant observations in the available literature provide qualitative assessments of post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. To enhance our understanding, Stussman et al. formed focus groups and listened to patients’ experiences to better understand post-extertional malaise. The authors found that the experience of post-exertional malaise in ME/CFS varies greatly between individuals and leads to a diminished quality of life. ME/CFS patients describe post-exertional malaise as all-encompassing with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover. Given the extensive variability in patients, further research identifying subtypes of post-exertional malaise could lead to better targeted therapeutic options.
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News ArticleMore than one in four patients with severe mental health conditions are missing diagnosis when they are admitted to hospital for other reasons, new research suggests. According to data analysed by scientists at University College London, those who are missing these mental illness diagnoses are more likely to be from ethnic minority groups or have a previously diagnosed mental illnesses. However, the situation has improved – in 2006 it was found that mental health diagnoses were missed in more than 50% of cases. "We found encouraging signs that clinicians are more frequently identifying severe mental illnesses in hospital patients than they were a decade ago,” Hassan Mansour, a research assistant at UCL psychiatry, said. “But there's a lot more that can be done, particularly to address disparities between ethnic groups, to ensure that everyone gets the best care available. Training in culturally-sensitive diagnosis may be needed to reduce inequalities in medical care." The researchers have suggested these findings may be due to language barriers or stigma felt by patients. It was also suggested that clinicians may be less able to detect these conditions in people from other ethnic and cultural groups. Read full story Source: The Independent, 18 September 2020
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News ArticleThe Health Information and Quality Authority (HIQA) has today published an overview report on the lessons learned from notifications of significant incident events in Ireland arising from accidental or unintended medical exposures in 2019. In 2019, HIQA received 68 notifications of significant events of accidental or unintended medical exposures to patients in public and private facilities, which is a small percentage of significant incidents relative to the total number of procedures taking place which can be conservatively estimated at over three million exposures a year.The most common errors reported were patient identification failures, resulting in an incorrect patient receiving an exposure. These errors happened at various points in the patient pathway which, while in line with previous reporting nationally and international data, highlights an area for improvement.John Tuffy, Regional Manager for Ionising Radiation, said “The overall findings of our report indicate that the use of radiation in medicine in Ireland is generally quite safe for patients. The incidents which were reported to HIQA during 2019 involved relatively low radiation doses which posed limited risk to service users. However, there have been radiation incidents reported internationally which resulted in severe detrimental effects to patients so ongoing vigilance and attention is required." John Tuffy, continued “As the regulator of medical exposures, HIQA has a key role in the receipt and evaluation of notifications received. While a significant event is unwanted, reporting is a key demonstrator of a positive patient safety culture. A lack of reporting does not necessarily demonstrate an absence of risk. Reporting is important, not only to ensure an undertaking is compliant but because it improves general patient safety in a service and can minimise the probability of future preventative events occurring.” Read full story Source: HIQA, 9 September 2020
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Content ArticleSince January 2019, the Health Information and Quality Authority (HIQA) has been the competent authority for regulating medical exposure to ionising radiation in Ireland and receives incident notifications of significant events arising from accidental or unintended medical exposures. As part of its role, HIQA is responsible for sharing lessons learned from significant events. HIQA has published an overview report on the lessons learned from notifications of significant incident events in Ireland arising from accidental or unintended medical exposures in 2019. This report provides an overview of the findings from these notifications and aims to share learnings from the investigations of these incidents.
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News ArticleA risk calculator that takes seconds to produce a score indicating a COVD-19 patient’s risk of death could help clinicians make care decisions soon after patients arrive in hospital, according to a large study conducted by a consortium of researchers across the UK. As UK COVID-19 cases rise, schools reopen and the weather gets colder, doctors at UK hospitals are expected to see an influx of coronavirus patients. Patients with COVID-19 behave very differently to patients with other conditions such as flu and bacterial pneumonia, said Dr Antonia Ho of the University of Glasgow, one of the study’s authors, and it is very challenging for doctors managing this unfamiliar disease to accurately identify those who are at high risk of deterioration or who can ride out their illness at home. “So having a tool that … can help clinicians at the front door to accurately group patients who are coming in with COVID-19 into four distinct risk categories – low, intermediate, high and very high risk – is hugely valuable,” she added. “Having an accompanying low-risk score will provide that doctor with increased confidence that the vast majority of people, patients with that low-risk score, will come to no real harm.” Read full story Source: The Guardian, 9 September 2020
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News Article
Plans for 150 new diagnostic hubs to cut rising waits
Patient Safety Learning posted a news article in News
Plans for up to 150 new community diagnostic hubs to tackle the NHS’ ballooning diagnostic waiting lists are included in NHS England ‘blue print plans’ leaked to HSJ. The document pointed out the hubs “were highlighted in the phase 3 letter [from Sir Simon Stevens] and will be recommended as part of new service models for diagnostics in the forthcoming [Sir Mike] Richards’ Review of Diagnostics Capacity”. It said “at least 150 community diagnostic hubs should be established in the first instance (broadly equivalent to the number of acute hospitals)” although it appears many of these may be temporary facilities. The phase 3 letter said systems should mange the “immediate growth in people requiring cancer diagnosis and/or treatment returning to the service by… the development of community diagnostic hubs” among other measures The Richards review was commissioned by NHS England in 2019 as it had long been recognised that England has one of the lowest levels in Europe of diagnostic equipment as well as a shortage in facilities and staff. Last month think-tanks warned of significant worsening of cancer outcomes because of the backlog in diagnosis and treatment created by a fall in referrals during the pandemic..." Read full story (paywalled) Source: HSJ, 4 September 2020 -
Content ArticleIs the Government oblivious to the avoidable harm caused to non-COVID patients as a result of disruption to health services during the pandemic? Or worse, is it trying to bury bad news? On 18 June 2020, Peter Walsh, Chief Executive, Action against Medical Accidents (AvMA), together with other organisations and experts, wrote to the Prime Minister and the First Ministers of the UK nations about avoidable harm being caused to non-COVID patients as a result of prolonged disruption to health services since the start of the COVID-19 pandemic. However, at the time of writing this blog, there has been no response to that letter Peter asks whether the failure to acknowledge the problem and ensure that it is urgently addressed, or even to show empathy with those affected, is at best irresponsible and deeply disrespectful to all those affected or at risk, or, at worst, whether it could be a conscious decision to bury bad news and avoid responsibility.
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Content ArticleBy understanding how physicians make clinical decisions, and examining how errors due to cognitive biases occur, cognitive bias awareness training and debiasing strategies may be developed to decrease diagnostic errors and patient harm. Studies of the impact of teaching critical thinking skills have mixed results but are limited by methodological problems. The authors of this paper, published in Academic Medicine, argue that explicit instruction in metacognition in medical education, including awareness of cognitive biases, has the potential to reduce diagnostic errors and thus improve patient safety.
