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Content Article
This report from Asthma + Lung UK highlights that lung diseases such as COPD, asthma and pneumonia are the third leading cause of death in England, whilst the UK as a whole has the worst death rate from lung disease in Europe. Hospital admissions for lung diseases have doubled in the last 20 years and lack of proper testing for lung diseases is having an impact on patient safety, as GPs have to "guess" diagnoses. The report highlights three areas where policy changes should be implemented in order to improve care for people affected, reduce pressure on services and deliver massive savings for the NHS: Diagnosing lung disease early and accurately Keeping people healthy and out of hospital Providing treatments that work -
Content ArticleDementia remains the biggest killer in the UK and is on track to be the nation’s most expensive health condition by 2030. This report by the charity Alzheimer's Research UK sets out a series of calls for party leaders ahead of the next general election, all of which are underpinned by an urgent recommendation for greater investment in dementia research.
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News Article
Sepsis often missed as 50% of screening tools don’t work, study finds
Patient Safety Learning posted a news article in News
Paramedics and A&E doctors often miss signs of sepsis and two of the four ways health professionals screen for the killer condition do not work, a new study claims. Doctors, NHS bosses and health charities have been concerned for years that too many cases of sepsis go undiagnosed, leaving people badly damaged or dead, because sepsis is so hard to detect. Unless a patient is diagnosed quickly, their body’s immune system goes into overdrive in response to an infection and then attacks vital tissues and organs. If left untreated, sepsis can cause shock, organ failure and death. Research from Germany, presented at this week’s European Emergency Medicine Congress in Barcelona, claims to have uncovered significant flaws in two of the four screening tools that health workers use worldwide to identify cases of the life-threatening illness. The four systems are NEWS2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome). The researchers analysed records of the care given to 221,429 patients in Germany who were treated by emergency health workers outside hospital settings in 2016. “Only one of four screening tools had a reasonably accurate prediction rate for sepsis – NEWS2. It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic cases,” they concluded. NHS England stressed that it already deploys NEWS2, which emerged as the best system. An NHS spokesperson said: “This study shows the NHS actually is using the best screening tool available for detecting sepsis – NEWS2 – and as professional guidance for doctors in England sets out, it is essential that any patient’s wishes to seek a second opinion are respected.” Read full story Source: Guardian, 20 September 2023 -
Content Article
Top picks: Six resources about sepsis
Patient Safety Learning posted an article in Deterioration and sepsis
According to the UK Sepsis Trust, sepsis affects 245,000 people every year in the UK alone, and 48,000 people die of sepsis-related illnesses. Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multi-organ failure, and death – especially if not recognised early and treated promptly. At Patient Safety Learning we believe that sharing insights and learning is vital to improving outcomes and reducing harm. That's why we created the hub; to provide a space for people to come together and share their experiences, resources and good practice examples. We have pulled together six useful resources about sepsis that have been shared on the hub. They include advice on recognising and managing sepsis along with educational materials. -
Content Article
Health Education England: THINK SEPSIS
Patient Safety Learning posted an article in Deterioration and sepsis
“THINK SEPSIS” is a Health Education England programme aimed at improving the diagnosis and management of those with sepsis. A number of sepsis cases result in death every year. Some of the deaths are preventable. Prompt recognition of sepsis and rapid intervention will help reduce the number of deaths occurring annually. The learning materials that are available on this website support the early identification and management of sepsis. It includes a film and a wide range of learning materials for primary care, secondary care and paediatrics. -
Content ArticlePatients and families are key partners in diagnosis, but there are few methods to routinely engage them in diagnostic safety. Policy mandating patient access to electronic health information presents new opportunities, and in this study, researchers tested a new online tool—OurDX—that was codesigned with patients and families. The study aimed to determine the types and frequencies of potential safety issues identified by patients with chronic health conditions and their families and whether their contributions were integrated into the visit note. The results showed that probable Diagnostic Safety Opportunities (DSOs) were identified by 7.5% of paediatric and adult patients with underlying health conditions or their families. Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. The most common types of DSOs were patients or families not feeling heard, problems or delays with tests or referrals and problems or delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories. The researchers concluded that OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients and families identified DSOs and most of their OurDX contributions were included in the visit note.
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Content ArticleA new issue brief from the Agency for Healthcare Research and Quality (AHRQ) examines the unique challenges of studying and improving diagnostic safety for children in respect to their overall health, access to care and unique aspects of diagnostic testing limitations for multiple paediatric conditions. The issue brief features approaches to address these challenges cross the care-delivery spectrum, including in primary care offices, emergency departments, inpatient wards and intensive care units. It also provides recommendations for building capacity to advance paediatric diagnostic safety.
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Content ArticleDiagnostic error research has largely focused on individual clinicians’ decision making and system design, largely overlooking information from patients. This article in the journal Health Affairs analysed a unique data source of patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The analysis identified 224 instances of behavioural and interpersonal factors that reflected unprofessional clinician behaviour, including ignoring patients’ knowledge, disrespecting patients, failing to communicate and manipulation or deception. The authors concluded that patients’ perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. They argue that health systems should develop and implement formal programs to collect patients’ experiences with the diagnostic process and use these data to promote an organisational culture that strives to reduce harm from diagnostic error.
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Content ArticleThe aim of this study from Hutchinson et al. was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department.
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Content ArticleCalibration, defined as alignment between a person’s diagnostic accuracy and their confidence in that accuracy, is an essential component of diagnostic excellence. Miscalibration—the misalignment between a person’s diagnostic accuracy and their confidence in that accuracy—can manifest as either overconfidence or underconfidence and can have serious consequences for patient diagnosis. This resource about calibration from the US Agency for Healthcare Research and Quality (AHRQ) is primarily aimed at individual clinicians whose scope of practice includes diagnosis. It focuses on processes involved in making a diagnosis and the outcome of giving an explanatory label to patients after these processes unfold.
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Content ArticleMost people experience a diagnostic error at least once in their lifetime. Patients’ experiences with their diagnosis could provide important insights when setting research priorities to reduce diagnostic error. The objective of this study from Zwaan et al. was to engage patients in research agenda setting for improving diagnosis. Patients were involved in generating, discussing, prioritising, and ranking of research questions for diagnostic error reduction.
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News Article
NHS cancer standards reform to speed up diagnosis for patients
Patient Safety Learning posted a news article in News
Thousands of people referred for urgent cancer checks every month are set to be diagnosed and treated sooner, as the NHS reforms its cancer standards to reflect what matters most to patients and to align with modern clinical practice. Developed by clinical experts and supported by leading cancer charities, there will be three cancer standards, which combine all of the previous standards and cover additional patients: the 28-Day Faster Diagnosis Standard (FDS) which means patients with suspected cancer who are referred for urgent cancer checks from a GP, screening programme or other route should be diagnosed or have cancer ruled out within 28 days. the 62-day referral to treatment standard which means patients who have been referred for suspected cancer from any source and go on to receive a diagnosis should start treatment within 62 days of their referral. the 31-day decision to treat to treatment standard which means patients who have a cancer diagnosis, and who have had a decision made on their first or subsequent treatment, should then start that treatment within 31 days. GPs will still refer people with suspected cancer in the same way, but the focus will rightly be on getting people diagnosed or cancer ruled out within 28 days, rather than simply getting a first appointment. The three agreed standards will come into effect from October. Read full story Source: NHS England, 17 August 2023 -
Content Article
Eating disorders training for health and care staff
Patient-Safety-Learning posted an article in Eating disorders
This series of training programmes was collaboratively developed by eating disorder charity Beat, Health Education England and NHSE. It was developed in response to the 2017 PHSO investigation into avoidable deaths from eating disorders, as outlined in recommendations from the report Ignoring the Alarms: How NHS Eating Disorder Services Are Failing Patients. It is designed to ensure that healthcare staff are trained to understand, identify and respond appropriately when faced with a patient with a possible eating disorder. It includes sessions relevant for different healthcare professionals and includes: Medical students and foundation doctors programme Nursing workforce sessions GP and Primary care workforce sessions Medical Monitoring in eating disorders Understanding Eating Disorders Webinar resource for dietitians, oral health teams and community pharmacy teams -
Content ArticleThis summary guide pulls together best practice to support NHS clinicians to better meet the Faster Diagnosis Standard for cancer. Getting It Right First Time (GIRFT) and NHS England’s Cancer Programme have worked in partnership to produce this guidance, which outlines how cancer alliances and local organisations can implement NHS England’s best practice timed diagnostic pathways for cancer. The guidance includes advice for all stages of a cancer diagnosis, from early identification of patients to onward referral, as well as useful insights from the relevant GIRFT national clinical leads and links to best practice case studies. This edition has a particular focus on colorectal cancer, prostate cancer and skin cancer.
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Content ArticleAll aspects of the diagnostic process are potentially vulnerable to error and this can occur in all healthcare settings and services. The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency investing in research to improve diagnostic safety and reduce diagnostic error in the United States. On this webpage they collate a range of different research, tools and resources related to improving diagnostic safety.
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News ArticleA man died after A&E doctors sent him home from hospital and “told him to drink Lucozade” despite him vomiting 100 times in 24 hours. Nick Rousseau died from an undiagnosed blocked bowel in 2019 after doctors at Milton Keynes Hospital failed to spot that he had the life-threatening condition. The 47-year-old was sent home twice in three days and reassured he “would be alright” as doctors believed he had gastroenteritis, his “devastated” wife Kimberly White said. But Mr Rousseau was actually suffering from an ischaemic bowel, a condition which blocks the arteries to the bowel. He had been to see his doctors several times and had lost three stones in weight over two years due to vomiting and diarrhoea but was never diagnosed. His family, represented by Osbornes Law, received a six-figure payout in June from Milton Keynes University Hospital NHS Foundation Trust. While it did not admit negligence, it accepted that there were features of Mr Rousseau’s illness which could have justified admission, inpatient observation, and further tests, which could have given a definitive diagnosis. Read full story Source: The Independent, 4 August 2023
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News Article
GPs given freedom to order heart checks direct
Patient Safety Learning posted a news article in News
GP practices in England will be able to order a host of checks directly to help speed up the diagnosis of a range of heart and respiratory conditions. Traditionally GPs refer to specialists when conditions like heart failure and lung problems are suspected. But the ability to direct refer, which was rolled out for cancer last year, is now being extended. GPs welcomed the move, but questioned whether there was sufficient testing capacity to cope. Royal College of GPs chair Prof Kamila Hawthorne said: "Any initiative to accelerate the process by which patients can be diagnosed and begin to receive any necessary treatment should be seen as positive." She said GPs had "long been calling" for better access to diagnostic tests. But she added: "For this initiative to be successful, it is vital that diagnostic capacity - both in terms of testing and people to conduct and interpret tests - is sufficient." Read full story Source: BBC News, 3 August 2023 -
Content ArticleHaving patients actively engaged in their care helps healthcare professionals develop more accurate, timely diagnoses. To help encourage this engagement, the Society to Improve Diagnosis in Medicine (SIDM) has developed the Patient's Toolkit, a resource for patients, by patients. Preparing ahead of time for medical appointments allows patients to think about concerns, symptoms, and other important information that healthcare professionals will need from you, and what you want to get out of the conversation during your visit. SIDM's toolkit was designed for patients visiting their healthcare provider to help tell their story clearly. Patients can follow a set of prompts and questions posed in the toolkit to help encourage participation and partnership with medical professionals. Prepare for you next appointment, map your symptoms, account for medications, and plan your next steps with the Patient's Toolkit.
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Content ArticleThis article looks at why health journalists should be more thorough in their approach to covering news relating to diagnostic errors. Leading researchers suggest that health care providers have done little to address the problem of diagnostic errors since a seminal report was released by the Institute of Medicine in 2015 describing the widespread harms from missed and delayed diagnoses. The article looks at the issues relating to diagnosis and highlights the importance of journalists reporting on solutions as well as stories of harm. It also focuses on how health journalism can play a key role in holding healthcare organisations to account.
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News ArticleMore than 250,000 dementia patients could miss out on new treatments for the disease because they do not have a formal diagnosis, according to government figures. NHS data published for the first time shows the prevalence of different types of dementia with which people in England have been diagnosed. Dementia is an umbrella term for many different conditions, affecting more than 55 million people worldwide. This week, health regulators were urged to approve two new game-changing dementia drugs, after a landmark study confirmed that donanemab slowed cognitive decline in Alzheimer’s patients by 35%, while last year, a second drug, lecanemab, was found to reduce the rate by 27%. The NHS primary care dementia figures estimate that there are about 708,000 people over 65 with dementia in England, but only about 450,000 have a recorded diagnosis. That means that more than 250,000 are missing out on these potential new treatments. Read full story Source: The Guardian, 20 July 2023
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News Article
ADHD and autism campaigners plan legal action against NHS over referral limits
Patient Safety Learning posted a news article in News
Campaigners are planning to launch legal action after NHS chiefs in North Yorkshire placed limits on which adults can get referrals for autism and attention deficit hyperactivity disorder (ADHD) assessments. North Yorkshire and York Health and Care Partnerships introduced a pilot programme in March in which adults seeking an NHS assessment for autism or ADHD are triaged via an online screening tool. NHS chiefs say this screening process prioritises those with the most severe needs, rather than processing referrals in chronological order. These priority needs reportedly include the patient being at risk of immediate self-harm or harming others, at risk of being unable to have lifesaving hospital treatment or care placement, or an imminent risk of family court decisions being determined on diagnosis. Those who do not meet the criteria are given guidance and signposted to other support networks. But campaigners say that in practise that means that most people cannot get a referral for an assessment – GPs can no longer make referrals themselves. Read full story Source: The Big Issue, 19 July 2023 Related reading on the hub: Long waits for ADHD diagnosis and treatment are a patient safety issue -
Content ArticleThe New Zealand Ministry of Health has released its first Women’s Health Strategy, which sets the direction for improving the health and wellbeing of women over the next 10 years. It outlines long-term priorities which will guide health system progress towards equity and healthy futures for women. The vision of the strategy is pae ora (healthy futures) for women. All women will: live longer in good health have improved wellbeing and quality of life be part of healthy, and resilient whānau and communities, within healthy environments that sustain their health and wellbeing. A key priority is equitable health outcomes for wāhine Māori, a commitment under Te Tiriti o Waitangi (The Treaty of Waitangi). The strategy also aims to help achieve equity of health outcomes between men and women, and between all groups of women.
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Content ArticleThis article from Sarcoma UK was written by Dermot’s family to develop their reflections and recommendations on the recent publication of the Healthcare Safety Investigation (HSIB) report, Variations in the delivery of palliative care services to adults.
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Content ArticleSafety netting is a consultation technique to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient’s condition. It is a way of managing clinical risk and helping patients identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health. Former GP Professor Paul Silverston discusses the purpose of safety-netting and offers advice on a structured approach to implementing it in practice. Further reading on safety netting: Safety-netting in general practice: how to manage uncertain diagnoses Optimising GPs’ communication of advice to facilitate patients’ self-care and prompt follow-up when the diagnosis is uncertain: a realist review of ‘safety-netting’ in primary care
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Content ArticleA series of videos on managing deterioration, including: Introduction to sepsis and serious illness Preventing the spread of infection Soft signs of deterioration NEWS What is it Measuring the respiratory rate Measuring oxygen saturation Measuring blood pressure Measuring the heart rate Measuring the level of alertness How to measure temperature Calculating and recording a NEWS score Structured communications and escalation Treatment escalation plans and resuscitation Recognising deterioration in people with a learning disabilities How to use your pulse oximeter and Covid-19 diary.
