Search the hub
Showing results for tags 'Emergency medicine'.
Found 375 results
-
Content ArticleCrammed wards, burned-out GPs, patients waiting hours for ambulances – the health service is at breaking point. The Guardian journalists, Andrew Gregory and Denis Campbell, take a look at the current NHS situation.
-
News Article
Trust drops from ‘outstanding’ to ‘requires improvement’
Patient Safety Learning posted a news article in News
A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission. CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety. The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt. Read full story (paywalled) Source: HSJ, 22 December 2022 -
News Article
The real test is yet to come as ambulance strike causes little disruption
Patient Safety Learning posted a news article in News
The NHS entered the last six hours of the ambulance strike with a sense that the real test will be seen in the coming days. Call volumes were down and many A&Es quieter than in previous days. NHS111 was very busy. Despite the fears expressed by leaders ahead of the strike not yet coming to fruition, the day ended with eight integrated care systems declaring critical incidents, along with all striking ambulance trusts and a number of hospital trusts. Leaders across the country told HSJ they feared that those who stayed away today in response to pleas for “common sense” amid industrial action may come back tomorrow, seeing demand return strongly. A senior London source said: “The ambulances will have stacked some calls and we may have a flood of movement tomorrow.” Read full story (paywalled) Source: HSJ, 21 December 2022 -
Content Article
Emergency medical technicians (EMTs) can operate as a single responder to an incident or support a paramedic on a double-crewed ambulance. They have many of the same skills as paramedics, such as being able to assess, triage and provide lifesaving treatment.[1] In this account, an EMT describes their current experience of being on the frontline. They talk about patient care, getting stuck in ambulance queues and how they have adapted to new ways of working, beyond their training. Lastly, they offer insight into where the solutions might lie and how improvements could be made. -
News Article
Fury as minister says strikers choosing to harm
Patient Safety Learning posted a news article in News
Ambulance unions have reacted with anger after the health secretary said they had "taken a conscious choice to inflict harm on patients". Steve Barclay said unions had refused to work with the government at a national level on how they would cover emergency calls during strike action. Unison said it was "utterly shocked" by the comments, while the GMB union said they were "insulting". Paramedics are among those striking in England and Wales on Wednesday. Control room staff and support workers who are members of the Unison, GMB and Unite unions are also involved. NHS bosses are warning patient safety cannot be guaranteed during the action, although unions say life-threatening callouts will still be responded to by an ambulance. They also argue patients are already being put at risk due to waiting times and the pressure on the health service, made worse by staff shortages. Read full story Source: BBC News, 21 December 2022 -
News Article
Risk to patients getting worse, NHS leaders warn
Patient Safety Learning posted a news article in News
The risk to patients will only get worse unless the government reaches an agreement to prevent further strikes, NHS leaders have warned. In a letter to the prime minister and health secretary, they said there was "deep worry" about today's strike. People are being asked to only call 999 in a life-threatening emergency, but NHS England says emergency care will continue to be provided. Ambulance response times are already twice as long as two years ago. The letter, signed by the leaders of NHS Confederation and NHS Providers, says the action being taken by ambulance workers "isn't just about pay but working conditions: many have said they are doing this because they no longer feel able to provide the level of care that their patients need and deserve." They urged ministers to "do all you can to bring about an agreed solution". Health Secretary Steve Barclay said the pay deal on offer to both ambulance staff and nurses had been agreed by an independent pay review body. In England, eight out of the 10 major ambulance services have declared critical incidents - a sign of the intense pressure they are already under. Ministers have urged the public to take extra care and suggested they avoid contact sports and unnecessary car journeys. Read full story Source: The Guardian, 21 December 2022 -
News Article
93-year-old left ‘screaming in pain’ on floor during 25-hour ambulance wait
Patient Safety Learning posted a news article in News
The Welsh ambulance service has apologised after a 93-year-old woman was left “screaming in pain” while lying on the floor with a broken hip during a 25-hour ambulance wait. Elizabeth Davies fell at her care home on Saturday and was finally picked up at 1.15pm on Sunday and admitted to Ysbyty Gwynedd hospital in Bangor on Monday, where she endured another 12-hour wait before being admitted to a ward. A hip fracture was later confirmed in surgery. Her family have said the incident, which occurred before a 24-hour strike on Wednesday by ambulance workers, was “unacceptable”. Her son, Ian Davies, from Pwllheli, said: “It was very upsetting to have to see her lying on the floor screaming in pain for over 24 hours.” After her injury, staff at the care home, where Davies has lived for 17 years, are understood to have propped a pillow under her head and tried to make her comfortable on the wooden floor, using a small heater to keep her warm in case she went into shock, as well as providing an absorbent pad so she could urinate. Her son, a community care worker, said: “They called for an ambulance but were advised an ambulance wouldn’t be available for six to eight hours as they were so busy. “They said my mother would be a priority because of her age. The care home then called us and we came immediately. “I don’t blame the ambulance staff because they are told what jobs to do and my mother wasn’t on the list.” It is understood the care home made nine calls, with a 10th made by Ian Davies. Read full story Source: The Guardian, 20 December 2022 -
News Article
Take car in emergency during 999 strike, says cabinet minister
Patient Safety Learning posted a news article in News
Patients should “make their own way to hospital” if they can do so during Wednesday’s strike by ambulance workers, a cabinet minister said yesterday, as the government warned that the industrial action would put lives at risk. Senior government figures said that ambulance unions had still not agreed national criteria for what conditions would be considered life threatening and responded to during the strike. Steve Barclay, the health secretary, is understood to be writing to all striking unions, including nurses, seeking discussions on patient safety. Yesterday Oliver Dowden, the Cabinet Office minister, said people should still call 999 in an emergency but might in less serious cases have to make their own way to hospital. “We are working to ensure that if you have a serious injury, in particular a life-threatening injury, you can continue to rely on the ambulance service, and we would urge people in those circumstances to dial 999,” he told Sunday with Laura Kuenssberg on BBC1. “If it is the case that you have less serious injuries, you should be in touch with 111, and you should seek to make your way to hospital on your own if you are able to do so.” Read full story (paywalled) Source: The Times, 19 December 2022 -
News Article
Emergency patients staying an extra day in ‘congested’ hospitals
Patient Safety Learning posted a news article in News
Patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid, consuming millions of additional ‘bed days’, HSJ analysis has found. The finding explains in part why fewer people are being treated in hospitals, but more resources are being consumed to do so. This has prompted concerns about an apparent big drop in productivity. NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”. Read full story (paywalled) Source: HSJ, 19 December 2022 -
News Article
Republic of Ireland: 'Unsafe' A&Es criticised as doctors warn of GP crisis
Patient Safety Learning posted a news article in News
Patients are not safe from harm in three out of seven emergency departments, a damning new Hiqa inspection report has revealed. The report was released on the same day as an Oireachtas committee was warned of a growing crisis in primary care, with patients in some parts of the country unable to access basic GP services. Emergency Departments in Cork University Hospital (CUH) and University Hospital Limerick (UHL) were among seven EDs assessed by the health watchdog. In three EDs, including Cork and Limerick, inspectors found failures to ensure “service providers protect service users from the risk of harm.” Inspectors also found patients’ “dignity, privacy and autonomy” was not respected in UHL, while CUH was only partially compliant in this area. The report also highlighted lengthy waiting times, including one patient who spent 116 hours on a trolley at UHL. Read full story Source: The Irish Examiner, 15 December 2022 -
Content ArticleThis report provides an overview of the findings of Ireland's Health Information and Quality Authority (HIQA)’s monitoring programme against the national standards in emergency departments in 2022. Throughout 2022, HIQA commenced a new monitoring programme of inspections in healthcare services against the National Standards for Safer Better Healthcare. As part of the initial phase, HIQA’s core assessment in emergency departments focused on key standards relating to governance, leadership and management, workforce, person-centred care and safe and effective care. The report highlights, HIQA has identified key areas for both immediate and longer-term attention to address safety issues in our emergency departments.
-
News Article
ER doctors in the US misdiagnose patients with unusual symptoms
Patient Safety Learning posted a news article in News
As many as 250,000 people die every year because they are misdiagnosed in the emergency room, with doctors failing to identify serious medical conditions like stroke, sepsis and pneumonia, according to a new analysis from the US federal government. The study by the Agency for Healthcare Research and Quality estimates roughly 7.4 million people are inaccurately diagnosed of the 130 million annual visits to hospital emergency departments in the United States. Some 370,000 patients may suffer serious harm as a result. Researchers from Johns Hopkins University analysed data from two decades’ worth of studies to quantify the rate of diagnostic errors in the emergency room and identify serious conditions where doctors are most likely to make a mistake. While these errors remain relatively rare, they are most likely to occur when someone presents with symptoms that are not typical. “This is the elephant in the room no one is paying attention to,” said Dr. David E. Newman-Toker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence, and one of the study’s authors. The findings underscore the need to look harder at where errors are being made and the medical training, technology and support that could help doctors avoid them, Dr. Newman-Toker said. “It’s not about laying the blame on the feet of emergency room physicians,” he said. Read full story Source: New York Times, 15 December 2022 -
Content ArticleDiagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). The authors from the John Hopkins University conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measured error and harm frequency, as well as assessing causal factors.
-
News Article
Ambulance strike threatens ‘different magnitude of risk’
Patient Safety Learning posted a news article in News
The ambulance staff strike next week represents a far higher risk to patient safety and services than the nurses’ strike, but a blanket elective ban will only be used as “an absolute last resort”, a senior NHS England director said today. However, NHSE elective recovery chief Sir Jim Mackey’s comments come despite several local leaders telling HSJ significant amounts of elective activity are likely to need to be postponed due to the ambulance staff walkout on 21 and 28 December, to free up capacity to deal with emergency care pressure. Speaking at a King’s Fund conference this morning, Sir Jim said: “The ambulance strike is a completely different order of magnitude of risk [than the nurses’ strike]. I think that’s the main thing people are worried about because of the complexity and fragility of urgent care.” However, he added: “If we were to give [national guidance on what elective activity to cancel] today, the only guidance we could give would be to cancel absolutely everything, and that’s really not going to help anybody… “I think we’ll just have to take it day-by-day and keep learning from each other and sharing intelligence… and then, if at some point, there is a case for blanket order, we’ll consider that… But, we really want to do that as an absolute last resort.” Read full story (paywalled) Source: HSJ, 15 December 2022 -
News ArticleVulnerable patients, including some children, have faced long delays for a suitable bed as organisations argue over whose responsibility it is to fund and deliver their care, HSJ understands. In a letter outlining winter arrangements, NHS England has warned trust leaders and commissioners against delaying emergency mental health admissions – typically needed when a patient is away from home, and understood to be more common over the Christmas period – while determining which area has which responsibility. National mental health director Claire Murdoch wrote: “It is not acceptable to delay an emergency mental health admission while determining which area has clinical and financial responsibility for the care of an individual.” She added such admissions should be arranged “as quickly as possible, and without delay caused by any financial sign-off process”. It comes as HSJ has been told patients can often end up waiting for several days in emergency departments or in “inappropriate” out of area or acute beds when disputes occur over who is responsible for their care. Read full story (paywalled) Source: HSJ, 15 December 2022
-
News ArticleMedics and nurses have been urgently called upon to support London Ambulance Service during next week’s strike action, as it will otherwise have to rely on staff only able to provide ‘first aid’. The North East London primary care team has sent out a request for clinical staff working for integrated care boards to be released from duties ahead of industrial action on 21 December. Unison members are preparing to walk out, alongside thousands of other staff at nine other ambulance trusts across the country, in a dispute over pay. The letter, seen by HSJ, was sent yesterday afternoon. It said: “LAS are keen to have experienced medics and nurses, who have current urgent and emergency clinical exposure, have knowledge of how to navigate the system and can operate as a senior clinical decision maker. Medical Practitioners would ideally be from general practice and emergency medicine. “Advanced Paramedics and Advanced Care Practitioners with urgent care or IUC CAS experience are also required. A knowledge of ambulance services is preferred as it removes the need to learn very quickly the significant differences in ambulance services and LAS control rooms." Read full story (paywalled) Source: HSJ, 13 December 2022
-
Content Article
.jpg.e948333192b4ea55d17766a6677b9801.jpg)
Jenny Edwards died in February 2022 from pulmonary embolism, following misdiagnosis. In this blog, her son Tim introduces us to Jenny, illustrating the deep loss felt following her premature passing. He talks about the care she received and argues that there were multiple points at which pulmonary embolism should have been suspected. Tim found the investigation that followed Jenny’s death to be lacking in objectivity and assurance that any learning could be taken forward. He has since produced an independent report, drawing on existing data, freedom of information requests and his mother’s case, to highlight broader safety issues.- Posted
- 2 comments
-
- (and 8 more)
-
Content Article
Roy Lilley eLetter - Helpless (12 December 2022)
Patient-Safety-Learning posted an article in Safe staffing levels
Writer and commentator Roy Lilley writes a daily email about what's happening on the ground in the NHS, and how this relates to policy decisions and guidance. Roy describes his eLetters as "a combination of opinion, my take on issues of the day and a news digest of things that I think are important or interesting." In this email, Roy shares several recent accounts sent to him by doctors and other healthcare professionals working in NHS hospitals. They describe dangerous staff ratios, overcrowding and medication shortages. The common theme is dangerously long working hours that could impact on patient safety. Sign up to receive Roy Lilley's daily eLetter. -
Content ArticleThis report by The Patient Experience Library looks at patient experience in urgent and emergency care (UEC), reviewing four years' worth of studies from sources including government bodies, policy think tanks, academic institutions and the local Healthwatch network.
-
Content ArticleThis article looks at the potential to use the continuous flow model to tackle unprecedented levels of overcrowding in emergency departments. The continuous flow model, also known as full capacity protocols, was first introduced in North America in the late 1990s. It mandates that a set number of patients are moved at set times from the emergency department to inpatient wards, regardless of whether a bed is available. This might mean putting an extra patient in a bay or two patients in a side room or boarding them in hospital corridors. In turn, this encourages wards to discharge existing patients, allows ambulances to offload new patients in the space created in the emergency department, and relieves pressure on the whole system. This article looks at the fact that evidence to support the continuous flow model is scarce, although positive, and that there are a number of important factors to consider before implementing the model, to ensure that it does not result in increased patient harm.
-
Content ArticleThis is an Adjournment Debate from the House of Commons on Wednesday 30 November 2022 on patient safety concerns relating to the diagnosis of pulmonary embolisms.
-
News ArticleMore than 200 people who died last week in England are estimated to have been affected by problems with urgent and emergency care, according to the president of the Royal College of Emergency Medicine. Dr Adrian Boyle, who is also a consultant in emergency medicine, told BBC Radio 4’s Today programme that a failure to address problems discharging patients to social care was a “massive own goal”. Ambulances had become “wards on wheels” while patients waited to get hospital treatment, Boyle said, adding that those most at risk “are the people that the ambulance can’t go to because it’s stuck outside the emergency department”. His comments came as the NHS launched 42 “winter war rooms” across England, designed to use data to respond to pressures on the health system. When asked about the project, Boyle said it was too early to tell if it was a good idea, adding: “You can paralyse yourself with analysis, it really is actually more simple and about building increased capacity.” He said the problem was best solved by focusing on hospital discharge and social care. “Fixing this starts at the back door of the hospital and being able to use our beds properly,” he said. “At the moment, there are 13,000 people waiting in hospitals, about 10% of the bed base, who are waiting to be discharged either to home, with a little bit more support, or to a care facility. And that’s just a massive own goal. We just need to reform the interface between acute hospitals and social care.” Read full story Source: The Guardian, 1 December 2022
-
Content ArticleIn this opinion piece for the Daily Mail, journalist Tom Utley recounts his recent experience of a seven hour wait at A&E after receiving abnormal blood test results from his GP. He argues that fear of litigation is causing GPs to refer patients on to A&E unecessarily, contributing to the overcrowding happening at emergency departments. He also highlights inefficiencies in the system and states that lack of staff capacity to tell him he didn't require any treatment meant he stayed an additional hour and a half in the waiting room.
-
Content ArticleWhen medical errors result in adverse patient outcomes, many healthcare professionals are concerned about malpractice litigation. Fear of malpractice has been associated with excessive health care use through defensive medicine, which involves doctors ordering additional testing or making extra referrals to protect themselves from malpractice accusations. The authors of this study in JAMA Network Open aimed to examine the perspectives of doctors on patient harm and malpractice litigation. They conducted an online survey targeting all emergency department attending physicians and advanced practice clinicians (APCs) in acute care hospitals across Massachusetts from January to September 2020. The results showed that although clinicians feared legal action, they feared harming patients to a greater degree regardless of specialty, experience or sex.
-
Content ArticleMoral injury is a specific kind of trauma that can happen when when people face situations that deeply violate their conscience or threaten their core values. This blog for Scientific American looks at the experience of ER doctor Torree McGowan when the Delta wave of Covid-19 hit the central Oregon region where she works. It examines the impact that moral injury has had on her mental health and her relationship with patients. The author looks at how Covid-19 hugely increased the incidence of moral injury as people in frontline roles faced ethically wrenching dilemmas every day. The growing realisation that moral injury is a separate diagnosis to other conditions such as PTSD and depression is resulting in a wider range of treatments and trauma therapies. Many of these treatments encourage people to face moral conflicts head-on rather than blotting them out or explaining them away, and they emphasize the importance of community support in long-term recovery.
.jpg.e948333192b4ea55d17766a6677b9801.jpg)
