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Found 373 results
  1. Content Article
    In this article for The Guardian, an anonymous hospital consultant describes the situation in many NHS emergency departments in January 2023—patients ready for medical admission waiting in ambulances in the hospital car park, patients receiving IV antibiotics in chairs in the corridor and staff completely overwhelmed by the workload. The author highlights that accident and emergency departments are now being used for a purpose for which they were not designed—looking after patients who need to be admitted to hospital wards. They describe the implications of this on patient safety and staff wellbeing and argue that the NHS and Government need to call the situation what it is—a crisis—or we will come to accept poor quality care and low patient safety standards as the norm.
  2. Content Article
    In November 2021, 15-year old Alice Tapper nearly died due to a missed diagnoses of a perforated appendix. In this opinion piece, Alice shares her experience of being admitted to hospital with intense abdominal pain and other serious symptoms. In spite of her parents' requests for imaging to rule out appendicitis, doctors diagnosed that Alice had a viral infection and refused to prescribe antibiotics. Alice's condition severely deteriorated, leading her father to call the hospital and beg a gastroenterologist for further investigation. Fortunately, the hospital granted his request and after an x-ray and ultrasound, Alice was found to have a perforated appendix. She was going into hypovolemic shock, when severe blood or other fluid loss makes the heart unable to pump enough blood to the body. Thankfully, emergency surgery and antibiotics saved Alice's life, but she reflects on the fact that without her father's intervention, she would probably have died. She describes how her doctors failed to take the concerns she and her parents repeatedly expressed seriously, and that this lack of responsiveness could have been fatal. She highlights research that shows that appendicitis is missed in up to 15% of paediatric patients, and that missed diagnosis is most common in children under five, and is more common in girls than boys.
  3. Content Article
    A prolonged stay in the emergency department before moving on to an in-hospital bed, another facility or departing home, is believed to have a negative effect on clinical outcomes for patients. This international systematic review and meta-analysis in the Journal of Clinical Medicine aimed to investigate the link between emergency department length of stay (EDLOS) and in-hospital mortality. The study's findings suggest two key associations with increased in-hospital mortality: low EDLOS EDLOS exceeding 24 hours The authors suggest that: long stays in the emergency department should not be allowed. special attention should be given to patients admitted after a short stay in the emergency department.
  4. 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.  
  5. Content Article
    As the NHS crisis has deepened in recent weeks, frontline staff have posted vivid, troubling accounts on social media of what has been happening in their workplaces. Many have described the NHS, and often themselves too, as “broken”. They have related the difficulty of providing proper care, the impact of acute understaffing and their fears for the NHS’s future. In this Guardian article, read some of what doctors, nurses and other NHS staff have been saying.
  6. Content Article
    NHS England has published its planning guidance for 2023/2023. The 2023/24 priorities and operational planning guidance reconfirms the ongoing need to recover our core services and improve productivity, making progress in delivering the key NHS Long Term Plan ambitions and continuing to transform the NHS for the future.
  7. 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.
  8. Content Article
    Crammed 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.
  9. Content Article
    This 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. 
  10. Content Article
    Diagnostic 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.
  11. 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.
  12. Content Article
    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.
  13. Content Article
    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.
  14. Content Article
    This 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.
  15. Content Article
    This 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.
  16. Content Article
    In 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.
  17. Content Article
    This 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.
  18. Content Article
    When 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.
  19. News Article
    Steve Barclay is back as England's health secretary, just as the NHS prepares for what its chief executive Amanda Pritchard says could be a "very, very challenging winter". The government has said "intensive work" is under way in the 15 most under-pressure hospital trusts in England, to speed up ambulance delays, free up beds and reduce waiting times in A&E. Emergency departments across the UK are struggling to quickly treat patients. Only 57% of people who turned up at major A&E departments in England last month were seen, admitted or discharged within four hours, well below the 95% national target. The latest figures from Gloucestershire Royal show it performs slightly worse than average, with 55% dealt with in four hours. One medic, speaking anonymously to the BBC, said: "I wouldn't bring a member of my family to this hospital. And winter is going to be worse unless something changes fast." Read full story Source: BBC News, 28 October 2022
  20. News Article
    A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis. Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers. Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk. He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk. “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there. “I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations. “Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.” Read full story (paywalled) Source: HSJ, 28 October 2022
  21. News Article
    Senior doctors have sent a warning over the “shambles” of heart attack care after pressures on the NHS have left patients waiting eight hours for an ambulance. The caution comes as several hospitals in the past week have declared critical incidents over the level of pressure on their emergency care services. Portsmouth Hospital said on Monday: “Demand for an emergency response is far outstripping the capacity available in Portsmouth and South East Hampshire at this time.” Professor Mama Mamas, a consultant cardiologist in Stoke and Professor of Cardiology at Keele University, told The Independent: “I was on call this weekend and I was seeing delays of eight hours. It was several people, three or four this weekend with heart attacks that waited between four and eight hours … it’s a national disgrace that we’re in this situation. “I think that patient care is being compromised. We know that time is muscle and an eight-hour delay getting an ambulance to a patient with a heart attack is impacting on the survival levels.” Read full story Source: The Independent, 13 October 2022
  22. News Article
    NHS England is developing plans for a new universal ‘community recovery service’ with a 24-hour target to provide ‘step down care’ once a patient is deemed ready to leave hospital, HSJ has revealed. Slides presented to an NHS England webinar reveal it is seeking to pilot “one single intermediate care step-down service [organised] at place through one lead commissioner”. It would include a target, or standard, requiring that when patients no longer meet the “criteria to reside in hospital”, they enter the new community recovery service within 24 hours. NHSE’s “vision” is that this 24-hour standard is met for all acute hospital patients within five years, the slides seen by HSJ reveal. The documents do not specify whether they would also be discharged within 24 hours. Delayed discharges have been a problem for many years, but have caused particularly huge difficulties in the past 18 months, leading to emergency department overcrowding and ambulance handover delays. In August, one in seven patients in acute hospitals were medically ready to be discharged, NHSE figures suggest. According to the documents seen by HSJ, key objectives for the new service also include reducing long-term care costs “by decreasing demand and acuity”, and ”increasing people’s functional outcomes” by giving more people better rehab care on discharge. This appears to be a recognition that at present many people discharged receive inadequate rehab, which can exacerbate their condition, requiring more care. Read full story (paywalled) Source: HSJ, 12 October 2022
  23. News Article
    Several ambulance trusts have moved to the highest level of alert in the wake of severe pressure on emergency services in recent days. Internal data seen by HSJ suggests ambulance response times have deteriorated dramatically, while the average time for call handlers to answer 999 calls has increased to almost two minutes in some areas. Staff across the country have been sounding the alarm over the pressures, with one senior source saying the situation was “really dire” again, after a period in which pressures had eased in August and September. The internal data showed ambulance trusts in the South West, East of England, London and the West Midlands had all declared the highest level of alert, known as REAP 4. More are expected to follow. The average response time for category 2 calls in the South West – including suspected heart attacks and strokes – was 1 hour 24 minutes, with 10% of these calls responded to in more than 3 hours 11 minutes. The target is 18 minutes. Emergency departments have also faced severe pressure. An emergency care consultant in Plymouth tweeted that patients were facing 70-hour waits to be admitted to wards, with some waiting 18 hours to be handed over by ambulance staff. Fionna Lowe added: “I have taken to asking families to feed their relatives. It has never been this bad.” Read full story (paywalled) Source: HSJ, 4 October 2022
  24. News Article
    An integrated care system which has some of England’s worst waiting times for emergency care lacks “delivery structure and processes” to make desperately needed improvements, according to an external report. Research by consultancy Prism into the Cornwall and Isles of Scilly integrated care system (ICS) concluded it had “unclear governance” for management and recovery of urgent and emergency care, with “multiple disconnected structures in place to manage tactical and strategic recovery of performance”. The report comes as the ICS grapples with record waits for emergency care, with stroke and heart attack victims waiting three hours for an ambulance and patients stuck for two days in Royal Cornwall Hospital’s emergency department. The review was commissioned by the Cornwall Integrated Care Board to look at patient flow across the system and make recommendations about how this can be improved. Prism interviewed leaders from the organisations within the Cornish ICS. One leader described the system as “so broken”, while another commented that the role of the ICB in supporting and delivering urgent and emergency care “is not clear”.
  25. News Article
    Patients seeking treatment for mental health problems at hospital emergency departments in England were twice as likely to experience "unacceptable" waiting times of 12 hours or more than other patients, according to a service review. The Royal College of Emergency Medicine (RCEM) described its findings as "unacceptable" and said the system frequently failed who were most unwell and vulnerable, particularly children and young people. The report, Mental Health and Emergency Care, is the latest in the RCEM's acute insight series summarising important issues in emergency care and making recommendations for policymakers, NHS England, integrated care systems, and trusts. The analysis noted that recorded prevalence of patients experiencing mental health needs had "dramatically increased" over the last 5 years. Despite accounting for a small proportion of attendances to emergency departments (EDs), a "mismatch" between capacity and demand, cuts to dedicated mental health hospital beds, and poor patient flow through the hospital system had led to long waits in recent months. The greatest concern was for patients waiting for a mental health bed, those waiting for assessment under the Mental Health Act, and children and young people presenting in crisis, the RCEM said. Read full story Source: Medscape, 22 September 2022
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