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Found 374 results
  1. Content Article
    As clinicians, our primary objective is to provide the best possible care to our patients. In this pursuit, the administration of short-term intermittent IV antibiotics plays a crucial role in combating infections and saving lives; however, there is an under recognised issue, under delivery, that results in the misuse of antibiotics and could be exacerbating antimicrobial resistance. In this blog, Claire Davies, Clinical Therapy Manager at B. Braun Medical Ltd., explores the issue of under delivery and provides essential insights for clinicians to optimise their antibiotic therapy.
  2. Content Article
    Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. The Safer Tracheostomy Care in Adults bundle was a programme of 18 interventions implemented across 20 hospitals in England between August 2016 and January 2018. These interventions were designed to improve the quality and safety of care for patients who have had tracheostomies. This evaluation report outlines why the interventions were needed and assesses their impact, including an estimated reduction in total hospital length of stay per tracheostomy admission of 33.02 days, corresponding to a potential reduction of over £27,000 per admission.
  3. News Article
    An ambulance spent 28 hours outside a hospital after an "extraordinary incident" was declared due to delays. The Welsh Ambulance Service said 16 ambulances had waited outside the emergency department at Morriston Hospital, Swansea, at one time. It said multiple sites across Wales were affected. The extraordinary incident, which asked people to only call 990 if their emergency was "life or limb threatening", is now over. Read full story Source: BBC News, 23 October 2023
  4. News Article
    A 25-year-old who died from a heart haemorrhage after being diagnosed with a panic attack had been seen by a non-medical school trained physician associate (PA) but not a doctor, it has emerged. Ben Peters, 25, attended the emergency department at Manchester Royal Infirmary on the morning of 11 Nov 2022 with chest pain, arm ache, a sore throat and shortness of breath. While waiting, he endured a “severe episode of vomiting”. Peters was diagnosed with a panic attack and gastric inflammation by the PA and sent home with two medications, after a supervising consultant, who the coroner found never reviewed the patient in person, agreed with the diagnosis. Less than 24 hours later, Peters died from a rare complication of the heart that had resulted in a tear of the heart’s major artery, known as aortic dissection, and led to a fatal haemorrhage. The Aortic Dissection Charitable Trust (TADCT) says around 2,000 people in Britain die from the condition each year, which can be “reliably diagnosed or excluded” using a CT scan, but “misdiagnosis affects one-third of patients”. A prevention of future deaths notice issued by Chris Morris, the area coroner for Greater Manchester South, written to Manchester University Foundation Trust, said: “It is a matter of concern that despite the patient’s reported symptoms, in view of his age and extensive family history of cardiac problems, Mr Peters was discharged from the Ambulatory Care Unit without being examined or reviewed in person by a doctor." Read full story Source: The Telegraph, 21 October 2023
  5. Event
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    This conference focuses on priorities for improving urgent and emergency care services in England. It will be an opportunity to examine progress and next steps for: the Delivery plan for recovering urgent and emergency care services - published by NHS England in January 2023 the Re-envisioning urgent and emergency care report - published by the NHS Confederation in December 2022. Stakeholders and policymakers will assess key priorities, including implementation and investment of the delivery plan, and the way forward for reducing waiting times and improving patient outcomes. Further sessions look at issues surrounding the workforce and service capacity, speeding up patient discharge, next steps for the same day emergency care policy, and the future outlook for virtual wards. Includes keynote sessions with: Ashley McDougall, Director, Health Value for Money, National Audit Office; Dr Adrian Boyle, President, Royal College of Emergency Medicine; and a pre-recorded contribution from Miriam Deakin, Director of Policy, NHS Providers. Overall, areas for discussion include: the delivery plan: progress, trends and challenges in delivering sustainable recovery of urgent and emergency care in England - priorities for improving accessibility workforce: what will be needed to deliver aims of the NHS Long Term Workforce Plan for emergency care strategies for growing the emergency care workforce, as well as training, professional development and retention priorities for supporting staff and addressing challenges for the workforce that are specific to emergency care waiting times: enabling same day emergency care targets to be met - latest thinking and best practice in effective hospital design, and developing capacity and flow - priorities for funding hospital bed occupancy: addressing issues with speeding up patient discharge - the role of social care and options for expanding care in the community - progress in delivery of virtual wards capacity and accessibility: the role of Integrated Care Systems in developing effective pathways for improving capacity - involvement of the independent sector quality: next steps for driving up standards - enabling long-term sustainable system recovery - priorities for aligning needs in emergency care with wider policy developments and initiatives Register
  6. Event
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    Agenda and registration
  7. News Article
    Thousands of people unaware they have type 2 diabetes could be diagnosed and avoid serious complications if screening was introduced in emergency departments, a study suggests. The prevalence of the disease has risen dramatically in countries of all income levels in the last three decades, according to the World Health Organization. More than 400 million people have been diagnosed, but millions more are estimated to be in the dark about the fact they have the condition. A study that took place in an NHS trust in England suggests 10% more cases could be picked up with the use of a simple blood test. Screening could also pick up 30% more cases of pre-diabetes – a serious condition where blood sugar levels are higher than normal. The findings are being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany. “Early diagnosis is the best way to avoid the devastating complications of type 2 diabetes, and offers the best chance of living a long and healthy life,” said Prof Edward Jude, of Tameside and Glossop integrated care NHS foundation trust. Read full story Source: The Guardian, 3 October 2023
  8. Content Article
    The National Early Warning Score (NEWS2) is calculated using routine vital sign measures of temperature, pulse and so on. It is used by ambulance staff and emergency departments to identify sick adults whose condition is likely to deteriorate.  NEWS2 has been shown to work among the general population. However, it has been unclear if it could monitor the condition of care home residents because of their age, frailty, and multiple long-term conditions. New research from the National Institute for Health and Care Research (NIHR) shows that, among care home residents admitted to hospital as an emergency, NEWS2 can effectively identify people whose condition is likely to get worse.
  9. Content Article
    Harold Pedley, known as Derek, attended his GP surgery during the late afternoon on 21.12.22 and after spending most of that day feeling unwell with symptoms including abdominal pain and vomiting. He was appropriately referred to the hospital and travelled there with his friend after his GP had discussed his case with doctors. Due to a lack of available beds in the assessment unit, Derek needed to remain in the emergency department. Following his arrival at 20.07 hours, doctors were not notified of his attendance. He remained in the emergency department waiting area for almost two hours during which time due to significant pressures faced by the department he was not assessed or spoken to by a medical professional. At 21.59 hours a triage nurse called for him. By then, Derek had been unresponsive for some time and had died, his death confirmed at 22.26 hours. A subsequent post mortem examination revealed he died from the effects of non-survivable extensive small bowel ischaemia caused by a significantly narrowed mesenteric artery. His death was contributed to by heart disease.
  10. News Article
    A coroner has warned that a private hospital is relying on NHS ambulances to transport patients despite “being fully aware” of the pressures on the ambulance service and resulting delays. The warning came at the end of an inquest into a patient who died after a 14-hour wait for an ambulance to transfer him from the private Spire hospital in Norwich to the NHS-run Norfolk and Norwich university hospital a few minutes’ drive away. The last two years have seen a succession of inquests relating to ambulance delays. But in the latest case Jacqueline Lake, senior coroner for Norfolk, expressed concerns over Spire hospital’s use of NHS ambulances when complications and emergencies mean its patients need NHS care. “Spire Norwich hospital does not deal with multi-disciplinary and emergency treatment at its hospital and transfers patients requiring such treatment to local acute trusts, usually the Norfolk and Norwich university hospital,” Lake wrote in a prevention of future deaths (PFD) report. “Spire Norwich hospital continues to rely on EEAST [East of England Ambulance Service NHS Trust] to transport such patients to the acute hospital, being fully aware of the demands placed on the EEAST generally and the delays which occur as a result.” Research suggests that nearly 600 patients were urgently transferred from private healthcare to NHS emergency care in the year to June 2021 across the UK – around one in a thousand private healthcare patients. But previous analysis by the Centre for Health and the Public Interest (CHPI) thinktank found that some private hospitals were transferring more than one in every 250 of their inpatients to NHS hospitals. ‘“Transferring unwell patients from a private hospital to an NHS hospital is a known patient safety risk which all patients treated in the private sector face – including the increased numbers of NHS patients who are now being treated in private hospitals because of government policy,” said David Rowland, director of the CHPI. “And despite numerous tragedies and despite the fact that politicians and regulators are fully aware of this risk, nothing has been done to address it.” Read full story Source: The Guardian, 23 September 2023
  11. Content Article
     On 3 August 2022, Geoffrey Hoad underwent a total hip replacement at The Spire Hospital. On 5 August 2022, Mr Hoad was diagnosed with a paralytic ileus and some respiratory compromise with gradually deteriorating renal function. On 6 August 2022, Mr Hoad’s transfer to Norfolk and Norwich University Hospital was agreed due to possible bowel obstruction, possible pulmonary infection and deteriorating renal function.   Ambulance service was called at 18:16 hours and again at 23.45. On 7 August 2022, the ambulance service was called again at 07.38 hours. The ambulance was on scene at 08:26 hours.         The medical cause of death was: 1a) Sub Acute Myocardial Infarction 1b)  Coronary Artery Atherosclerosis 2) Hospital Admission for Post Operative lieus.
  12. Content Article
    Overcrowding in the emergency department (ED) is a global problem that causes patient harm and exhaustion for healthcare teams. Despite multiple strategies proposed to overcome overcrowding, the accumulation of patients lying in bed awaiting treatment or hospitalisation is often inevitable and a major obstacle to quality of care. This study in BMJ Open Quality looked at a quality improvement project that aimed to ensure that no patients were lying in bed awaiting care or referral outside a care area. Several plan–do–study–act (PDSA) cycles were tested and implemented to achieve and maintain the goal of having zero patients waiting for care outside the ED care area. The project team introduced and adapted five rules during these cycles: No patients lying down outside of a care unit Forward movement Examination room always available Team huddle An organisation overcrowding plan The researchers found that the PDSA strategy based on these five measures removed in-house obstacles to the internal flow of patients and helped avoid them being outside the care area. These measures are easily replicable by other management teams.
  13. Content Article
    Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. Brady et al. aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU).
  14. Content Article
    A 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. 
  15. Content Article
    The early use of automated external defibrillators (AEDs) improves outcomes in out-of-hospital cardiac arrest (OHCA). This study in the journal Heart investigated AED access across Great Britain according to socioeconomic deprivation. The authors found that in England and Scotland, there are differences in distances to the nearest 24/7 accessible AED between the most and least deprived communities. They concluded that equitable access to ‘out-of-hours’ accessible AEDs may improve outcomes for people with OHCA.
  16. Event
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    The Patient Safety Incident Response Framework (PSIRF) encourages investigations across the NHS to apply SEIPS. This 3 hour masterclass will focus upon using SEIPS in Emergency Departments. The SEIPS trainer Dr Dawn Benson has extensive experience of using and teaching SEIPS, as a Human Factors tool, in health and social care safety investigation. She will be joined in these masterclass sessions by clinical subject experts. Register
  17. Event
    The Patient Safety Incident Response Framework (PSIRF) encourages investigations across the NHS to apply SEIPS. This 3 hour masterclass will focus upon using SEIPS in paramedic – urgent & emergency care. The SEIPS trainer Dr Dawn Benson has extensive experience of using and teaching SEIPS, as a Human Factors tool, in health and social care safety investigation. She will be joined in this masterclass session by a clinical subject expert. Morning session: 9.30-12.30 Afternoon session: 1.30-4.30 Register
  18. Content Article
    Delays in the handover of patient care from ambulance crews to emergency departments (EDs) are causing harm to patients. A patient’s health may deteriorate while they are waiting to be seen by ED staff, or they may be harmed because they are not able to access timely and appropriate treatment. This national investigation sought to examine the systems that are in place to manage the flow of patients through and out of hospitals and consider the interactions between the health and social care systems (the ‘whole system’). This report brings together the findings from the investigation’s three interim reports and provides an update since they were published. You can view the interim reports on the hub: Interim report 1 (16 June 2022) Interim report 2 (3 November 2022) Interim report 3 (27 February 2023)
  19. News Article
    Record numbers of people have been hospitalised with heart attacks in the wake of the pandemic, official figures show. On Tuesday, health chiefs will launch a campaign urging those with symptoms to seek help, with fears that too many cases are being detected too late. The new figures for England show that more than 84,000 patients were admitted to hospital because of a heart attack in 2021/22 – a rise of more than 7,000 in a year. It follows warnings that heart deaths have risen by more than 500 a week since the first lockdown, with a fall in the numbers prescribed vital medication amid struggles to access GP care. Health officials are afraid that people are still failing to come forward, adding to the collateral damage caused by the pandemic. From this week, an NHS advert will encourage people to call 999 as soon as they experience symptoms of a heart attack, such as squeezing across the chest, sweating and a feeling of uneasiness, so people have the best chance of survival. Prof Nick Linker, a cardiologist and NHS national clinical director for heart disease, said: “Cardiovascular disease causes one in four deaths across the country, so it is vital that people are aware of the early signs of a heart attack. Every moment that passes during a heart attack increases heart muscle damage, and nearly all of the damage takes place within the first few hours, so if you experience symptoms such as a sensation of squeezing or tightness across the chest alongside sweating, nausea, or a sense of unease, please call 999 so you have the best chance of a full recovery”. Read full story (paywalled) Source: The Telegraph, 15 August 2023
  20. News Article
    A ‘disappointingly slow’ transformation of community services means thousands of mental health patients are still presenting at emergency departments within weeks of being discharged from an inpatient facility. Experts said an NHS England-led community transformation programme, launched in 2019 as part of a £2.3bn investment in mental health services, should have helped reduce readmission rates, but internal data seen by HSJ suggests the rates have actually increased since then. The data reveals for the first time the proportion of patients discharged from inpatient care who then present to accident and emergency within two months. The proportion of adult patients was 11 per cent in 2018-19, when the investment programme was launched, and had increased to 12 per cent by 2022-23, representing around 6,000 adult cases. The situation appears worse for children, with an 18 per cent readmission rate within two months, up from 17 per cent in 2018-19. Read full story Source: HSJ, 8 August 2023
  21. News Article
    Dangerous allergic reactions are rising in England and now cause some 25,000 NHS hospital stays a year, according to data gathered by the NHS and analysed by the Medicines and Healthcare products Regulatory Agency. Health officials say the rate has more than doubled over 20 years, prompting them to issue advice reminding people how to recognise allergies and respond. For severe food-related allergic reactions, the rise in admissions is even greater. The figures suggest anaphylaxis is on the increase, though some of the rise could be attributed to the growth in population. Anaphylaxis can be fatal and develop suddenly at any age. People who know they are at risk should always carry two adrenaline pens which they, or someone else, can administer in an emergency. In addition, people at risk of an anaphylactic reaction should regularly check the contents of their adrenaline pens have not expired. They should see a pharmacist to get a new one if a pen is close to expiring. Read full story Source: BBC News, 28 July 2023
  22. News Article
    The Royal College of Nursing (RCN) has said patients are waiting for days in corridors at Belfast's Royal Victoria Hospital's Emergency Department. Rita Devlin, NI director of the RCN, visited the unit on Thursday after getting calls from nursing staff. She described the situation as "scandalous". Speaking to Radio Ulster's Evening Extra programme, Ms Devlin said while it was the Royal Hospital on Thursday, the situation is "bad right across the EDs". She said talking to nurses at the Royal, she was struck by "the absolute despair" some are feeling. "I spoke to some young, newly qualified nurses who are leaving because they just can't take the stress and the pressure any more," she said. Read full story Source: BBC News, 20 July 2023
  23. Content Article
    A casually centred proposal identifying how Fire and Rescue Services can improve pre-hospital care and quality of life outcomes for burn survivors.  David Wales and Kristina Stiles have released this report looking at the burn survivor experience in the pre-hospital environment. The work makes ten operational recommendations and also two 'lessons learned' recommendations exploring strategic partnership working and the resulting fragmented services.
  24. News Article
    Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements. Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care. The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention. It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”. Read full story (paywalled) Source: HSJ, 18 July 2023
  25. Content Article
    NHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. While the covid-19 pandemic has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decades long and unless urgent action is taken, we may not yet have reached its nadir, writes Tim Cooksley and colleagues in this BMJ opinion article.
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