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Showing results for tags 'Emergency medicine'.
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News Article
Mental health patients face 'unacceptable' waits for emergency care
Patient Safety Learning posted a news article in News
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 -
Content ArticleThis instalment of Royal College of Emergency Medicine (RCEM)’s Acute Insight Series summarises key issues in mental health emergency care and provides recommendations for policymakers, NHS England, Integrated Care Systems, and Trusts to enable patients to access emergency mental healthcare in a safe, efficient, and timely manner.
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News Article
‘Gross’ care delays could become ‘new normal’, says CQC report
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has urged system leaders to move away from “quick fixes” to the “enormous gap in resources and capacity” in urgent and emergency care. A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”. The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances. The report, 'People First: a response from health and care leaders to the urgent and emergency care system crisis', suggests: expanding use of urgent community response teams to attend minor injuries 999/111 calls, giving acute and social care providers direct access to GP and community service booking systems, and providing “rapid access” to support packages to help people avoid hospital admission. Read full story (paywalled) Source: HSJ, 22 September 2022 -
Content ArticlePEOPLE FIRST is a CQC resource to help system leaders and service providers.
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Content ArticleHealthcare settings are high-risk environments for fatigue and staff burnout. The Need For Recovery (NFR) scale quantifies inter-shift recovery, which contributes to cumulative fatigue and may precede occupational burnout. Advanced clinical practitioners (ACPs) are an established feature of the emergency medicine workforce in the UK, however, little is known about factors affecting their inter-shift recovery, fatigue or how NFR correlates with formal burnout inventories.
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News Article
Hospital issues ‘full capacity’ alert days before move to smaller building
Patient Safety Learning posted a news article in News
A major acute site has issued a ‘full capacity’ alert to staff, just days before the services are due to move into a replacement hospital with fewer beds. In an email seen by HSJ, medical leaders at the Royal Liverpool Hospital alerted staff to extreme pressures on the site, with ambulances being held outside and “no space” in resuscitation areas. The RLH currently has around 685 beds, but at the end of this month the services are due to start transferring to the long-awaited new Royal Liverpool, on an adjacent site. The new hospital has 640 beds, and several frontline staff have told HSJ this is causing significant concern, with the current services under so much pressure. One senior source at the trust said there has been a push since 2017 to reduce inpatients beds at the current hospital, to try and match the capacity of the new build, but this hasn’t been achieved. They added: “Surgeons are concerned that their beds will get filled with medical outliers. The whole issue is all the patients who are waiting for social care. It was supposed to have been sorted by now.” Read full story (paywalled) Source: HSJ, 13 September 2022 -
Content ArticleThese resource lists compiled by US insurance company MedPro Group, highlight a number of expert and evidence-based sources that can be used to increase awareness of safety issues, identify areas of risk and determine mitigation strategies. They cover a wide range of healthcare safety topics: Advanced practice providers Anaesthesia and surgery Artificial Intelligence Bed safety and entrapment in senior care Behavioural health Behavioural health in senior care Burnout in healthcare Culture of safety Cybersecurity Disclosure of unanticipated outcomes Disruptive behaviour Elder abuse Electronic Health Records Emergency medical Treatment and Labour Act Emergency preparedness and response Emergency preparedness and response in senior care organisations Ergonomics and safe patient handling Falls and fall risk in older adults Handoffs and care transitions Health equity and social determinants of health Health literacy and cultural competence Healthcare-associated infections Healthcare compliance HIPAA Human trafficking and trauma-informed care Infection prevention and control in ambulatory care settings Infection prevention and control in dentistry Infection prevention and control in senior care organisations Informed consent LGBT+-inclusive care Maternal morbidity and mortality Medical marijuana Medication safety during care transitions Obstetrics and gynaecology Opioid prescribing and pain management Patient engagement Pressure injuries in older adults Sepsis Social media in healthcare Staff shortages and workforce issues Suicide screening in primary care Telehealth/telemedicine Violence prevention in home healthcare Violence prevention in the Emergency Department Wrong-site procedures
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News Article
Doctors warn Truss over NHS ‘fantasy’
Patient Safety Learning posted a news article in News
Liz Truss has been warned against “fantasy predictions” that the NHS can return to normal without radical change and was told that “unacceptable standards” are being normalised. In a rare political intervention, the professional standards body for the UK’s 220,000 doctors agreed that the NHS was routinely letting down patients. The Academy of Medical Royal Colleges said politicians must be prepared for radical changes to save the health service. Closing smaller hospitals, accepting that routine dentistry cannot be free for everyone and a return of Covid volunteers to allow doctors to treat more patients were all suggested by the head of the academy. The academy released a report that declared the NHS was in crisis, writing: “The system is providing increasing proportions of care or services which are sub-standard, threaten patient safety, and should not be acceptable in a country with the resources that we have in the United Kingdom. If we do not act with urgency, we risk permanently normalising the unacceptable standards we now witness daily.” The report sets out a series of recommendations for reform, including boosting staff numbers, reforming social care and spending more on technology. Helen Stokes-Lampard, the academy’s chairwoman, said patients were facing a “dismal winter” and that politicians must take difficult decisions. “If we don’t make changes it will inevitably deteriorate further,” she said. “The demand isn’t going away, the pressure isn’t going away, which is why the challenge for our government and for our whole society is to confront these issues and have a difficult conversation.” Read full story (paywalled) Source: The Times, 9 September 2022 -
Content ArticleThe NHS Confederation, NHS Providers, the Academy of Medical Royal Colleges, National Voices and the Richmond Group of Charities have penned a joint letter to the new Prime Minister warning that without urgent action on key priorities the NHS risks being trapped in a relentless cycle unable to meet rising patient need and demand. The five organisations, which together represent NHS leaders, clinicians and patients, are calling on the new government to take rapid action to address five key priorities in the short term. These priorities are: Workforce Social care Capital funding The impact of the cost of living crisis and inflation Strengthening the voice of people living with ill health in decision making.
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News Article
We need to find alternatives to 999 for care homes and falls
Patient Safety Learning posted a news article in News
The NHS needs to do more to support care homes and people who have fallen with alternatives to ambulance calls and hospital admissions, the NHS England chief executive has said. Speaking at the Ambulance Leadership Forum, Amanda Pritchard acknowledged this winter would be a difficult one for the health service, saying: “The scale of the current and potential challenge mean that we do need to continue to look further for what else we can do… We need to pull out all the stops to make sure that they [patients] get that treatment as safely as possible and as quickly as possible.” She added one area of focus should be making sure certain patient groups can access other – more appropriate – forms of care, rather than calling an ambulance by default and often resulting in hospital admission. On care homes, she said: “Can we wrap around even more care for these care homes so they get to the point where they don’t need to call for help at all or, if they do, there are alternatives pathways [to the emergency department]?” She suggested another area where responses could be made more consistent was for patients who had fallen but without serious injuries, which she said made up a “really significant part of activity”. These patients took a long time to reach and, if admitted to hospital, risked long admissions, she said. Some areas were working to find other ways of responding to non-injury falls patients and trying to keep them away from hospital, she said. Read full story (paywalled) Source: HSJ, 6 September 2022 -
News Article
Why Canada's ERs are struggling to stay open
Patient Safety Learning posted a news article in News
On a Thursday in mid-August, the doors of a hospital's emergency department two hours west of Toronto were shut. A note posted on the front said the ER was closed for the day. It would reopen the following morning at 08:00, but close again for the evening. Patients who needed urgent care were asked to go to nearby hospitals - a 15- to 35-minute drive away. It was the ninth time since April that the Huron Public Healthcare Alliance - a network of four hospitals serving around 150,000 people in western Ontario - had to temporarily close or cut back hours at one of its emergency departments. Canada is one of the richest countries in the world. Its universal publicly funded healthcare system has been touted by progressive politicians in the US, the country's southern neighbour, who see it as a needed alternative to an American system where millions remain uninsured. But in recent months, Canada's system has been described by workers and hospital executives as being in a state of "crisis". That includes struggling emergency rooms. Toronto ER physician Dr Raghu Venugopal said he has seen stretchers lining the hallways, occupied by patients suffering from ailments like a broken hip or abdominal pains. On some days, those patients may wait anywhere from two to four days to be admitted to hospital, all while a team of two nurses tends to a total of 50 to 60 patients on the unit. Other patients are being examined in the waiting room because the lack of staff has forced parts of the ER to close, meaning there is limited space for doctors to see them privately. "We are in a standard-less void where anything goes, and it is shocking," Dr Venugopal said. Read full story Source: BBC News, 2 September 2022 -
Content ArticleThis report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) examines the quality of care provided to patients aged 16 years and over who were admitted to hospital following an out-of-hospital cardiac arrest (OHCA). The report is based on the findings of a study that looked at the clinical care delivered to patients from the time of an OHCA to discharge from hospital or death. The review of the clinical pathway included the community and emergency service response, hospital admission and inpatient care (in particular cardiac and critical care services). Data were also collected to assess organisational aspects of care within acute hospitals.
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Content ArticleThis National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report reviews the quality of care of patients aged 16 and over who had a pulmonary embolism (PE), The study aimed to highlight areas where care could be improved in patients with a new diagnosis of acute PE. A retrospective case note and questionnaire review was undertaken in 526 patients aged 16 and over who had a PE, and who either presented to hospital or developed a PE whilst an inpatient for another condition. You can view and download the following documents: Full report Summary report Summary sheet Recommendation checklist Infographic Slide set Commissioners' guide Fishbone diagram Audit toolkit YouTube video: Know the Score
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News ArticleFirefighters have resorted to taking people to hospital in fire engines amid rocketing call-outs to medical emergencies. Fire and rescue services now respond to more “non-fire incidents” than fires in England, including cardiac arrests, suicide attempts and elderly people trapped in their homes after falls. Official statistics show that they attended more than 18,200 medical incidents in 2021-22, an increase of a third from the previous year, and that firefighters rather than ambulances were the “first responder” in almost half of those calls. Chris Lowther, who chairs the National Fire Chiefs’ Council’s operations committee, said the figures showed a “new reality” as firefighters step in to help struggling ambulance services. Read full story Source: The Independent (22 August 2022)
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News Article
NHS 111 chaos may harm patients, experts claim
Patient-Safety-Learning posted a news article in News
Patients may come to harm as a result of NHS 111 chaos, experts claimed on Tuesday as patients were advised to avoid the service this weekend. The helpline for urgent medical advice was targeted by cyberhackers earlier this month, leaving staff working on pen and paper. The Adastra computer software, used by 85 per cent of 111 services, was taken offline after the attack leaving call handlers unable to book out-of-hours urgent appointments and fulfil emergency prescriptions. But almost three weeks on, most staff are still operating without the system, leaving GPs unable to see patients’ medical records during urgent consultations or automatically forward prescriptions to pharmacies. The NHS has told hospitals to prepare public awareness campaigns to “minimise” pressures on urgent and emergency care services this winter. Some hospitals have already issued messaging urging patients not to turn up at accident and emergency (A&E), unless they are facing a “serious emergency.” Helen Hughes, chief executive of the charity Patient Safety Learning, said the continuing chaos raises “serious patient safety concerns” and will “inevitably result in avoidable harm”. Telling patients not to go to A&E “unless it is absolutely necessary” is only possible if GPs and NHS 111 “have the capacity and the resources to meet the demands that this places on them”, Ms Hughes said. “Significant delays in receiving a response are potentially missed opportunities for patients to receive timely medical advice and treatment that may prevent future harm,” she added. “Delays in receiving timely care and treatment will inevitably result in avoidable harm to patients.” Read full story (paywalled) Source: The Telegraph (23 August 2022) -
News Article
Government examines surge in ‘potentially preventable’ deaths
Patient Safety Learning posted a news article in News
Department of Health and Social Care (DHSC) officials are concerned that many more people are dying than expected in recent months – particularly older working-age people – with NHS care delays and interruptions a likely cause. HSJ understands there is concern and analysis under way across the chief medical officer’s team and in the Office for Health Improvement and Disparities. The DHSC told HSJ initial work showed the biggest causes of the “excess deaths” were cardiovascular disease (heart attacks and strokes) and diabetes. This supports the case they are being caused by a combination of the current very long delays for ambulances and other emergency care, and by people with heart disease and diabetes missing out on routine checks due to Covid and its knock-on effects, HSJ was told. Read full story (paywalled) Source: HSJ, 17 August 2022 -
Content ArticleAs dentists hand back their NHS contracts in record numbers, GPs are seeing the impact on their workload and patients’ health, especially in “dental deserts,” reports Sally Howard in this BMJ article. Over one week this spring, 20 patients presented at GP Abbie Brooks’ York surgery with abscesses, dental pain, and broken teeth—demanding antibiotics and painkillers. Brooks could not prescribe because she was not indemnified to perform dental work. Many of these patients, Brooks says, were not registered with a dentist or able to find an NHS dentist, and had already been told to call 111. The NHS medical helpline had advised patients to visit emergency NHS dentists 50 miles away from Brooks’ surgery. “Vulnerable patients often can’t get to emergency dentist appointments in Bradford or Leeds for logistical or financial reasons,” she says, adding that a small proportion of patients became difficult when Brooks was unable to help. “One woman was really quite angry that I wouldn’t incise and drain her abscess,” she says. “It’s not acceptable for GPs to have to deal with this crisis not of our doing.”
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Content ArticleThe UK has fewer hospital beds than almost any other European comparator and we can ill afford any loss of hospital capacity. While Covid has undoubtedly worsened performance, crowding in emergency departments was a problem before the pandemic. There are frantic attempts to shore up battered and fragile rotas and rota coordinators are scratching their heads. Meanwhile there has been a steady increase in the number of staff off work with Long Covid. While many have been flexible and accommodating to try to maintain their services, there is increasing burnout and uncertainty as to when all this will end. The workforce needs to feel valued and supported, writes Adrian Boyle, a consultant in emergency medicine. There needs to be an acknowledgment that the system is broken.
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Content ArticleIt is 20 years since researchers discovered that patients admitted to hospitals on Saturdays or Sundays are more likely to die than those admitted Monday to Friday. The ‘weekend effect’ was assumed to be because fewer hospital specialists work at weekends, meaning care was less good. However, there was no evidence to support this assumption. This NIHR Alert is based on: This NIHR Alert is based on: Bion J, and others. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. Health Services and Delivery Research 2021;9:13.
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Content ArticleForeign body ingestions are common events among paediatric patients. Button battery ingestions are particularly dangerous. Although the incidence of button battery ingestions has not changed over the last 30 years, the rates of emergency department visits, major morbidity, and mortality have risen dramatically since the introduction of the 3-volt–20 mm lithium batteries in 2006. These batteries are larger and more powerful than their predecessors, which has increased the incidence of esophageal impaction and significant tissue injury. The overall incidence of major morbidity or mortality after button battery ingestion is 0.42%. However, in children under six years old who ingest batteries >20 mm, the rates of major complications are as high as 12.6%. All reported fatalities have occurred in children under five years old. This article in the Anesthesia Patient Safety Foundation newsletter looks at the perioperative management of children who have ingested a button battery.
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News Article
Trust chief calls for six-hour A&E target
Patient Safety Learning posted a news article in News
The chief executive of a trust trialling the new emergency care standards being considered by the government has called for a new six-hour target to either move patients out of accident and emergency, or for them to receive treatment. North Tees and Hartlepool Foundation Trust chief executive Julie Gillon told HSJ a new target should be set as a “body of evidence” indicates patients are at risk of deterioration following A&E waits of six hours or more. The proposal is likely to be broadly welcomed by many clinicians, but could prove controversial in some quarters. NHS England did not include a six-hour target in the bundle of new A&E metrics being piloted, and the proposal could be interpreted by some as a watered-down version of the existing four-hour standard. However, Ms Gillon cited analysis by the Royal College of Emergency Medicine last year which revealed thousands of excess deaths resulting from overcrowding and long stays in A&Es. Read full story (paywalled) Source: HSJ, 4 August 2022 -
News Article
Trusts reveal thousands of new 12-hour waits
Patient Safety Learning posted a news article in News
Several trusts have now started reporting thousands of 12-hour waits in their emergency departments, representing a huge difference to the numbers published nationally under a slightly different measure. This year, trusts have started submitting data to NHS England on the number of patients waiting over 12 hours from time of arrival in ED, until discharge, admission or transfer. Many trusts are now reporting these statistics in their public board reports. This is a slightly different measure to the publicly reported “trolley wait” figures, which count waits of over 12 hours from decision to admit until admission. Experts have long argued the trolley wait measure does not capture the true problem of ED overcrowding and delayed care. The new data captures a far higher number of patients and has not been published nationally by NHSE. Read full story (paywalled) Source: HSJ, 2 August 2022 -
Content ArticleThis video examines the crisis facing NHS ambulance services in the UK and looks at the impact of delays and lack of capacity on patient safety. Paul Brand, UK Editor at ITV News, speaks to ambulance crews, patients and a recently bereaved family about their experiences, and highlights the increased stress levels ambulance staff are reporting. Note: The video contains footage of a 999 call that some viewers might find distressing.
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Content ArticleAfter 12 years of brutal service, Neil Barnard, an NHS emergency medicine consultant, is leaving his NHS post to work abroad. His decision to leave is driven by financial and personal reasons. More than anything, he says he's tired and has little more left to give to the NHS.
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News ArticleHealthcare systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system. As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics. Victoria, meanwhile, has committed an additional A$162 million for system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping. But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again? We also need to consider better care in the community – and paramedics could play a role in this too. Read full story Source: The Conversation, 21 July 2022
