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Found 375 results
  1. Content Article
    This article, published in BMC Health Services Research, discusses the effectiveness of using checklists as training and operational tools to assist in improving the skills of general ward staff on the rescue of patients with abnormal physiology.
  2. Content Article
    This article, published in ICU Management and Practice, explores how human factors are significant contributors to drug error. To overcome some of these human factors, standardisation and consolidation is needed of agreed drugs and equipment into a compact pre-packed critical care drugs pouch (CCP) for use in non-theatre environments.
  3. Content Article
    There has been a lot of discussion about whether the NHS will be overwhelmed this winter, if it is already overwhelmed, or if it is just having yet another “normal” winter crisis and will get through, as it always has, despite the additional pressures from omicron. The sight of the army being deployed in hospitals and ambulance services should be a clue that all is not well, but we are on a “war footing” after all. But can we be more precise about our current state?, writes Katherine Henderson, President of the Royal College of Emergency Medicine, in this BMJ opinion piece. Is the healthcare system delivering the needed level of patient care? The problem of the elective backlog—known and unknown—is well documented. Individual patients have lost months, or even years of good health. They have anxiety, pain, and debilities that limit their ability to engage fully with their families and society. But how about the ability of the NHS to provide safe and effective emergency care to the most seriously ill, distressed, or injured—the emergency part of the urgent and emergency care pathway? What service should we be delivering, and how do we match up to those standards at the moment?
  4. News Article
    A troubled integrated care system has been told it must provide more help to a severely under-pressure acute trust where patients were treated on the floor and in a storeroom. The Care Quality Commission said Devon ICS must give more “input” to University Hospitals Plymouth Trust, where inspectors warned staff could “not ensure the safety of all patients” arriving at the emergency department. During a visit to the trust’s Derriford Hospital in September, inspectors saw staff treating six patients who “lay on the floor” of the ambulatory assessment unit, while another patient who had been in the department overnight was being “treated/assessed in the ‘storeroom’” – according to the CQC’s report. Inspectors reported: “The department was overcrowded, there was no seating available… Social distancing was not possible.” While the CQC praised senior leaders in the ED and executive chiefs for being “open to challenge” and “understanding the problems” faced by the urgent and emergency care service, inspectors said there was only so much the trust could do alone. Catherine Campbell, head of hospital inspection at CQC, said: “The impact of a high number of patients attending to receive care, combined with reduced staffing levels in the ED, created issues that the trust couldn’t solve alone and further support was needed from the local health and social care system." Read full story (paywalled) Source: HSJ, 19 January 2022
  5. Content Article
    Delays to timely admission from emergency departments (EDs) are known to harm patients. In this study, Jones et al. assessed and quantified the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England.
  6. News Article
    Hospitals are not able to cope with current pressures, senior doctors have warned, as a new study links long A&E waits to an increased risk of death. Patients waiting more than five hours within an emergency department are at an increased risk of dying, according to a study published in the Emergency Medicine Journal (EMJ). The study’s findings come as emergency care performance across England continues to deteriorate, and as pressures across hospitals mean that more patients are waiting for more than four hours in A&E departments than ever before. According to the research, death rates for patients waiting between six and eight hours before admission to hospital were 8% higher, and they were 10% higher for those waiting eight to 12 hours. The study was based on data collected prior to the pandemic, and national A&E waiting times have since deteriorated further. In November last year, the Royal College of Emergency Medicine (RCEM) warned that long delays and overcrowding in A&Es may have caused thousands of deaths during the pandemic. Researchers said that although cause and effect could not be established between longer waits and deaths after 30 days of hospital admission, they recognised a statistically significant trend. The paper said: “Long stays in the emergency department are associated with exit block and crowding, which can delay access to vital treatments. And they are associated with an increase in subsequent hospital length of stay, especially for older patients. Read full story Source: The Independent, 19 January 2022
  7. Content Article
    Is it realistic to think of separating NHS hospital sites more effectively for “cold” (elective) and “hot” (acute and urgent) care, so that outbreaks or seasonal surges don’t lead to elective care being cancelled or delayed? David Oliver, consultant in geriatrics and acute general medicine, explores this idea in a BMJ article.  
  8. Content Article
    We catch up with a regular contributor to the hub, theatre nurse Kathy Nabbie, to discuss how she is continuing to ensure patient's are kept safe in theatre, the challenges of COVID-19 and what else we can do to improve safety in the theatre. Kathy was a theatre sister for breast oncoplastic surgery and a practice development lead in a London private hospital group up until August 2017. She now works as a locum theatre bank scrub nurse practitioner and once a week as a non-medical surgical first assistant. She also works for an insourcing company on weekends around the country to help with the backlog of NHS patients who need surgery or treatment in clinics.
  9. Content Article
    Gomes et al. report the utilisation and impact of a novel triage-based electronic screening tool (eST) combined with clinical assessment to recognise sepsis in paediatric emergency department. An electronic sepsis screening tool was implemented in the paediatric emergency departments of two large UK secondary care hospitals between June 2018 and January 2019. Patients eligible for screening were children < 16 years of ages excluding those with minor injuries or who were brought directly to resuscitation.  Utilisation of a novel triage-based eST allowed sepsis screening in over 99% of eligible patients. The screening tool showed good accuracy to recognise sepsis at triage in the ED, which was augmented further by combining it with clinician assessment. The screening tool requires further refinement through multicentre evaluation to avoid missing sepsis cases.
  10. Content Article
    Failure to rescue (FTR) denotes mortality from post-operative complications after surgery with curative intent. High-volume, low-mortality units have similar complication rates to others, but have lower FTR rates. Effective response to the deteriorating post-operative patient is therefore critical to reducing surgical mortality. Resilience Engineering might afford a useful perspective for studying how the management of deterioration usually succeeds and how resilience can be strengthened.
  11. Event
    until
    This face-to-face event by The Royal College of Emergency Medicine will look at research around burnout and other psychological impacts of working in the emergency department. It will feature talks from clinicians promoting staff wellbeing and explore opportunities to work with the Sustainable Working Practice Committee. View the event programme Book this event. Reduced fees are available for RCEM members and student members LMIC clinicians and students.
  12. News Article
    An acute trust in the Midlands is planning to move patients to chairs on wards to free up beds for people waiting in its emergency department, following one of its “most challenged” days. In an email sent to staff at Nottingham University Hospitals on Tuesday, interim chief operating officer Rachel Eddie and chief medical officer Keith Girling wrote: “We are asking wards to transfer [patients confirmed as ready for discharge] to the discharge lounge, or if that isn’t possible, move them to a chair on the ward so that a patient waiting for a bed in ED or in an emergency pathway assessment area can be brought up.” “This is referred to as going ‘one over’,” the email added. “We will ensure that on each ward that has been designated as being able to go ‘one over’, a chair has been added to their Nervecentre ward layout so patients are all visible.” The email describes how Monday was one of the “most challenged Mondays we have seen” and confirmed the trust remains in ‘Opel 4’, the most severe level of operational pressure. It also said nursing staff have “shared concerns” about the amount of time they are able to spend with their patients. “This does mean that at times you will be asked to work at a higher patient to nurse ratio than we would like,” the email said. “We know this isn’t where any of us want to be, but it is unfortunately the reality of balancing risk.” Read full story (paywalled) Source: HSJ, 1 December 2021
  13. News Article
    Changes must be made across services at one of England's biggest NHS trusts following its first wide-ranging inspection, a health watchdog said. Mid and South Essex NHS Foundation Trust - which runs Basildon, Southend and Broomfield hospitals - has been rated as "requires improvement". The Care Quality Commission (CQC) turned up unannounced after concerns over standards were raised. Philippa Styles, the CQC's head of hospital inspection, said they "found a mixed picture" of positive improvements and areas of concern. "Following the trust's formation in 2020, leaders should now be able to work together effectively to ensure care is consistent across all services," she said. "I recognise the enormous pressure NHS services are under... and that usual expectations cannot always be maintained, especially in the urgent and emergency department, but it is important they do all they can to mitigate risks to patient safety." The report said: Patients had not always been protected from harm. Staff had not all received mandatory training. There had been nine "never-should-happen" medical events. Records were sometimes inaccurate and not kept securely. Nursing and medical staffing was a "challenge across the trust", with shifts regularly below planned staffing numbers. There had been a high number of whistle-blowers raising concerns. Read full story Source: BBC News, 1 December 2021
  14. Content Article
    This article in the journal Resuscitation examines the needs of the 'forgotten patient' in out-of-hospital cardiac arrests (OHCA), which have a mortality rate of between 80 and 90%. Unlike many other critical illnesses, family members and partners often witness the collapse or have to perform CPR on their friend or loved one. The traumatic burden associated with these events can be significant, resulting in unique psychosocial needs both for survivors and those who witness or perform CPR. The partner or caregiver may struggle to deal with the fear, anxiety and guilt associated with the arrest, CPR provision and subsequent care upon discharge of their loved ones from hospital. This often makes the caregiver a ‘forgotten patient’ and there is growing literature examining the high levels of stress, anxiety, anger and confusion experienced by caregivers of survivors in the first 12 months after OHCA.
  15. Content Article
    Prehospital care is the care received by a patient from an emergency medical service before arriving at a hospital. This systematic review in the International Journal for Quality in Health and Care aimed to identify: how the prevalence and level of harm associated with patient safety incidents (PSIs) in prehospital care are assessed. the frequency of PSIs in prehospital care. the harm associated with PSIs in prehospital care.
  16. Content Article
    The Extensive Care Service is part of the Fylde coast Vanguard and is designed for frail elderly patients with two or more long-term conditions who are at high-risk of an emergency admission. Working closely with patients, the service aims to assist them to improve their health and wellbeing; support them to manage their own conditions and provide effective interventions when needed in order to better manage exacerbations of their conditions. One of the key components of the care model is patient activation. The service teams’ understanding of an individual’s ability to contribute to the management of their own health and wellbeing is key to ensuring the success of this approach. The model is new, different and includes the development of a unique role - a ‘wellbeing support worker’. These individuals are a consistent feature in a model which enables a fuller understanding of a patient’s ‘activation’ ability so that engagement and support can be tailored appropriately. 
  17. Content Article
    This 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. This investigation reviewed the case of a woman who was taken to an emergency department by ambulance in April 2021, following a 999 call from her Granddaughter to the emergency operations centre. The emergency operations centre used the wrong NHS number for the patient, which was assigned to her for the duration of her stay in hospital and led to her being offered incorrect medication.
  18. Event
    until
    Infection is a leading cause of childhood deaths, but many of these deaths are avoidable with timely treatment. The national Before Arrival at Hospital Project (BeArH), funded by the National Institute for Health Research (NIHR), explored what happens to children under five years of age with serious infections before they are admitted to hospital. The aim of this research was to explore what helps children get help quickly and what might slow this process down, so that lessons could be learned for the care of this group of children in the future. This forum will be led by Professor Sarah Neill, Dr Damian Roland and Natasha Bayes. To join the research forum and hear the findings of this important research project from the study team, email lpt.research@nhs.net for the Microsoft Teams link.
  19. News Article
    Thousands of patients a year are dying because of overcrowding in A&E units in Britain, and more fatalities will follow this winter, emergency care doctors claim. An estimated 4,519 people in England died in 2020-21 as a direct result of people receiving less than ideal care while delayed in A&E waiting to start treatment in the hospital. “To say this figure is shocking is an understatement. Quite simply, crowding kills,” said Dr Adrian Boyle, a vice-president of the Royal College of Emergency Medicine (RCEM). There have also been 709 deaths in Wales and 303 in Scotland so far this year for the same reason, according to a report by the college. Another 566 excess deaths caused by overcrowding occurred in Northern Ireland in 2020-21. The 4,519 in England “may be an underestimate”, it adds. The four figures taken together mean the college has identified at least 6,097 deaths across the four home nations that it believes occurred because overcrowding hampered the person’s treatment. “There’s a lot of human misery behind these figures. It’s uncomfortable and unbearable that people are being put through this. It’s impossible not to feel upset and angry about this,” Boyle said. Read full story Source: The Guardian, 18 November 2021
  20. Content Article
    This document outlines the Royal College of Emergency Medicine’s (RCEM) systemwide plan to improve patient care. The RCEM CARES campaign addresses pressing issues facing emergency departments (EDs) so that staff can deliver safe and timely care for patients. The campaign focuses on five key areas: Crowding, Access, Retention, Experience, and Safety.
  21. News Article
    An NHS ambulance service boss has urged 999 callers to not hang up as "there may be a delay before we pick up". The East of England Ambulance Service (EEAS) said demands on the health service meant it was extremely busy. Marcus Bailey, EEAS chief operating officer, said delays were due to a "combination" of Covid, winter pressures and recruitment. He said the service planned to recruit 100 call-handlers over the next few months to help ease pressure. The EEAS has published posters online telling emergency callers to be patient. The service covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk. Mr Bailey told BBC Look East: "It's about us warning people who are phoning 999 that it's really busy and at some points there may be a delay before we pick up the 999 call. "Remain on the line, don't hang up, and we will get to you as soon as possible." Read full story Source: BBC News, 9 November 2021
  22. Content Article
    Hot debriefs are interactive, structured team conversations that take place immediately or very shortly after a clinical case. They are designed to help the whole team learn from the experience, reflect on what went well, identify team strengths or difficulties and to consider ways to improve future performance. In this blog, the authors describe how a multidisciplinary focus group at Edinburgh Emergency Medicine, alongside staff from the Scottish Centre for Simulation and Clinical Human Factors (SCSCHF), developed “STOP5: STOP for 5 Minutes”, a new tool to facilitate hot debriefs.
  23. News Article
    Inside the emergency department at Sparrow Hospital in Lansing, Michigan, staff members are struggling to care for patients showing up much sicker than they’ve ever seen. Tiffani Dusang, the ER’s nursing director, practically vibrates with pent-up anxiety, looking at patients lying on a long line of stretchers pushed up against the beige walls of the hospital hallways. “It’s hard to watch,” she said. But there’s nothing she can do. The ER’s 72 rooms are already filled. “I always feel very, very bad when I walk down the hallway and see that people are in pain, or needing to sleep, or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute,” Dusang said. The scene is a stark contrast to where this US emergency department — and thousands of others — were at the start of the pandemic. Except for initial hot spots like New York City, in spring 2020 many ERs across the country were often eerily empty. Terrified of contracting covid-19, people who were sick with other things did their best to stay away from hospitals. Visits to emergency rooms dropped to half their typical levels, according to the Epic Health Research Network, and didn’t fully rebound until this summer. But now, they’re too full. Even in parts of the country where covid isn’t overwhelming the health system, patients are showing up to the ER sicker than before the pandemic, their diseases more advanced and in need of more complicated care. Read full story Source: Kaiser Health News, 29 October 2021
  24. Content Article
    This review by Healthcare Inspectorate Wales considers the impact of ambulance waits outside emergency departments on the overall experience of patients, which included their safety, care, privacy and dignity. It covers the period between 1 April 2020 and 31 March 2021, during the Covid-19 pandemic. The report highlights that although patients were positive about their experience with ambulance crews, handover delays are having a detrimental impact upon the ability of the healthcare system to provide responsive, safe, effective and dignified care to patients. It makes 20 recommendations for consideration by the Welsh Ambulance Services NHS Trust, health boards and the Welsh Government.
  25. Content Article
    Emergency Department *ED) crowding has potential detrimental consequences for both patient care and staff. Advancing disposition can reduce crowding. This may be achieved by using prediction models for admission. This systematic review from Brink et al. aims to present an overview of prediction models for admission at the ED. Furthermore, we aimed to identify the best prediction tool based on its performance, validation, calibration and clinical usability.
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