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Showing results for tags 'Emergency medicine'.
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Content ArticleEmergency general surgery (EGS) involves care and treatment of a patient's often previously unknown disease in an unplanned interaction with the healthcare system. This leads to challenges in collecting and interpreting patient reported outcome measures (PROMs). This study in the American Journal of Surgery aimed to capture the peri-operative experiences of 30 patients at 6 to 12 months after their treatment. The authors found that: two-thirds reported feeling no choice but to pursue emergency surgery with many reporting exclusion from decision-making. Females reported these themes more commonly. patients with minor complications less frequently reported trust in their team and discussed communication issues and delays in care. patients with major complications more frequently reported confidence in their team and gratefulness, but also communication limitations. patients not admitted to the ICU more frequently discussed good communication and expeditious treatment.
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Content ArticleProlonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours.
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Content Article
WHO Emergency care system framework (2 May 2018)
Patient-Safety-Learning posted an article in WHO
This infographic is a visual representation of the WHO Emergency Care System Framework, designed to support policy-makers wishing to assess or strengthen national emergency care systems. It is the result of global consultations with policy-makers and emergency care providers and provides a reference framework to: characterise system capacity. set planning and funding priorities. establish monitoring and evaluation strategies. -
News ArticleHospitals are being pressured to shift their resources to treating patients with less serious conditions to meet a “politically motivated” target, according to multiple senior sources. The pressure appears to be coming through NHS England’s regional teams, with local sources saying they are being told to focus energies on patients in their emergency departments who do not need to be admitted to a ward. These cases are typically faster to deal with, and therefore shifting resources to this cohort could significantly improve performance against the four-hour target. However, experts in emergency care repeatedly warn that admitted patients are the most likely to suffer long waits and harm. The NHS has been tasked with lifting performance against the four-hour target to 76% in 2023-24, but has failed to meet that in any month this year. Performance in December was 69%. Some trust leaders told HSJ they would ignore the instructions, saying they would continue to focus resources on reducing the longest waits. One chief executive in the north of England said: “It’s a complete nonsense and just politically motivated. We’re getting a very clear message to hit 76 per cent which is hugely problematic because it will drive non patient focussed behaviour. We have said ‘no, we are focussing on long waiters and ambulance delays’… in other words doing the right thing for patients.” Read full story (paywalled) Source: HSJ, 5 February 2024
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Content ArticleEmergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. This study found that lean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.
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News ArticleReductions in the number of long ambulance delays have come at a “huge cost” as hospitals are having to take in more emergency patients than they have space for, NHS England’s urgent care director has said. Sarah-Jane Marsh told NHS England’s board meeting on Thursday that emergency departments and hospital wards are now taking more “risk” by taking extra patients in a bid to get ambulances back on the road quicker. This year, many fewer hours have been lost to ambulance delays, although the total number of delays of more than 60 minutes is approaching the same as last winter. Emergency department waits in November and December were better than last year, although still much worse than pre-covid and a long way below targets. But Ms Marsh said the improvement was a result of hospitals agreeing to take more patients into EDs and acute wards, even when they did not have space or staff to properly care for them. She said: “It’s come at a huge cost. Some of the things we have achieved are because we have moved pressures around in the system. “We have moved risk out of people’s houses and from the back of ambulances, and in some cases we’ve moved that into emergency departments [and] wards, that have had to take the pressure of taking additional patients. “Next year one of our learnings is that we need to have a really big focus on what is happening inside our hospitals [so] we decongest some very crowded areas.” Read full story (paywalled) Source: HSJ, 1 February 2024
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Content ArticleExpecting paramedics to wade through shared care records is unsafe and inefficient. In an emergency, access to essential information has to be easy and fast, writes Claire Jones from NHS England South West. Whilst ambulance services may need access to the entire longitudinal record, it is imperative that in those first vital minutes of an emergency they have the most pertinent and relevant data at their fingertips. In such cases, information sharing can be a matter of life or death. We should make it as easy as possible for emergency care providers to access and view relevant information about the person in their care.
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News Article
USA: ED boarding at crisis levels, Mass General says
Patient Safety Learning posted a news article in News
Boston-based Massachusetts General Hospital is requesting permission from the state to add more than 90 inpatient beds amid what it says is an "unprecedented capacity crisis." The hospital's emergency department has experienced critical levels of overcrowding nearly every day for the past six months, Massachusetts General said in a news release. The hospital boards between 50 to 80 ED patients every night who are waiting for a hospital bed to open. On 11 January, Massachusetts General had 103 patients boarding in the ED, representing one of the most crowded days in the hospital's more than 200-year history. "While hospital overcrowding has significantly affected patient care for many years, COVID-19 and the post-pandemic demand for care has escalated this challenge into a full-blown crisis – for patients seeking necessary emergency care, as well as for staff who are required to work under these increasingly stressful conditions," David F.M. Brown, president of Massachusetts General, said in a news release. Massachusetts General's request comes as hospitals across the state grapple with capacity issues, workforce shortages and a jump in respiratory illnesses this winter. On 9 January. the Massachusetts Department of Public Health issued a memo urging hospitals to expedite discharge planning amid the capacity crunch. Some health plans have also waived the need to obtain prior authorisation for short stays in post-acute care facilities. Read full story Source: Becker Hospital Review, 19 January 2024 -
EventuntilFundamentals of Emergency Medicine Education is a 2-day, 17-hour course that provides participants with the knowledge and skills to become effective educators in emergency medicine. Through a dynamic and interactive format, the course focuses on best practice, strategies, updates, and educational innovations to optimize the educational environment in your Emergency Department. This course is designed for faculty at any career stage who work with trainees and are seeking a comprehensive foundation in medical education. The goal of this course is to teach fundamentals of medical education to improve the teaching and learning in your department. Register
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Content ArticleThis article in The Lancet examines the role of national public health institutes (NPHIs) in dealing with health emergencies in the Eastern Mediterranean region. NPHIs are science-based organisations or networks concerned with public health functions in countries. The Covid-19 pandemic highlighted the importance of NPHIs and their potential in future emergency preparedness and response (EPR). A 2022 global review acknowledged the contribution of more than 13 NPHIs in the Eastern Mediterranean region during the pandemic and called for more clarity on the future role of NPHIs in EPR. These NPHIs have different governance models, organisational mandates, capacities and links within national and global systems—and this complexity raises questions about how they should best be engaged in EPR.
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Content ArticlePatients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organisations and healthcare, and the extent of patient safety incidents is still unclear. This study in the Journal of Patient Safety is based on in-depth interviews with eight experienced Norwegian HEMS physicians from four different bases from February to July 2020. The study aimed to explore the physicians’ experience with incident reporting and their perceived areas of risk in HEMS. The authors concluded that sparse, informal and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. A focus on organisational factors and system responsibility is needed to further improve patient safety in HEMS, alongside research on environmental and contextual factors.
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Content ArticleThe NHS remains under immense pressure. Each part of the system is experiencing demand beyond its capacity, which is continually increasing the problem. This is most vividly illustrated in urgent and emergency care settings. Each winter in the past decade has become slightly worse,2 and that trend, which has not been reversed, has resulted in a dire situation that may not yet have reached its nadir. A continuum of often predictable perfect storms has caused a struggling system to reach collapse, writes Tim Cooksley, immediate past president, Society for Acute Medicine in this BMJ opinion piece.
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News Article
How portable X-ray machines are helping remote patients
Patient_Safety_Learning posted a news article in News
Portable X-ray machines "can literally be the difference between life and death", says radiographer Sam Pilkington. For most of us, if we need to be X-rayed the procedure is done in a hospital. But for acutely unwell patients, or for infection control, Ms Pilkington says that portable machines are very helpful. This is because "they remove the excess burden of transportation from the patients", says the final-year student at the University of the West of England in Bristol, who is also a member of the Institute of Physics. Instead the X-ray equipment goes to them. There are obvious advantages for remote locations, including battlefields, roadsides and disaster zones. Read full story Source: BBC News, 8 January 2024 -
Content Article
Lions Clubs Message in a Bottle (MIAB)
Patient_Safety_Learning posted an article in Emergency medicine
Lions Clubs Message in a Bottle is a simple but effective way for people to keep their basic personal and medical details where they can be found in an emergency on a standard form and in a common location – the fridge. Message in a Bottle (known within Lions as MIAB) helps emergency services personnel to save valuable time in identifying an individual very quickly and knowing if they have any allergies or take special medication. Find out more about the initiative and how to order a bottle via the link below. -
Content ArticleThis is the report, together with formal minutes relating to the report, by the House of Commons Public Accounts Committee looking at Access to urgent and emergency care. It includes a number of conclusions and recommendations relating to: Productivity, accountability and oversight Service performance NHS workforce.
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Content ArticleNHS hierarchies and paternalistic cultures can mean patients’ and families’ concerns are dismissed or undermined—but challenging them can be lifesaving. In this opinion piece for the BMJ, Zosia Kmietowicz shares the story of her son's experience at A&E, when a nurse intervened to question a doctor's treatment plan to ensure he received antibiotics for meningitis. She highlights the need for a system that allows staff to intervene when they are concerned, regardless of their status or position in the system.
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Content ArticleHealthcare Inspectorate Wales (HIW) is the independent inspectorate of the NHS and regulator of independent healthcare in Wales. The findings of their Annual report outline the sustained pressure on healthcare services across Wales, highlighting risks relating to emergency care, staffing concerns, poor patient flow and the accessibility of appointments. It sets out how the HIW carried out their functions across Wales, seeking assurance on the quality and safety of healthcare through a range of activities. This includes inspections and review work in the NHS, and regulatory assurance work in the independent healthcare sector. The report provides a summary of what HW's work has found, the main challenges within healthcare across Wales, and HIW's view on areas of national and local concern.
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Content Article
This report by the Royal College of Emergency Medicine presents insights about Emergency Department (ED) crowding in England. It highlights that overcrowding is a major threat to public health and outlines the reasons for overcrowding - primarily increasing patient demand coupled with high hospital bed occupancy, which has resulted in exit block. -
Content ArticleChristina Ruse was admitted to the Spire Hospital on 14 December 2021 and underwent a total left hip replacement. Her condition deteriorated and observations were commenced at five minute intervals. Mrs Ruse was reviewed and on further deterioration in her condition it was decided to transfer her to the High Dependency Unit, Norfolk and Norwich University Hospital. On arrival of the ambulance Mrs Ruse was undergoing a further investigatory procedure. On this being completed Mrs Ruse was taken to the Norfolk and Norwich University Hospital, where her condition continued to deteriorate and she died on 15 December 2021.
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Content ArticleBarbara Hollis underwent a total left knee replacement operation on 22 February 2022. The surgery was uneventful with no complications, however after her return to the ward Mrs Hollis became restless and confused. Following a review of her deteriorating condition the decision was made to transfer her to the High Dependency Unit at the Norfolk and Norwich University Hospital. Arrangements were made for the transfer and the ambulance service was called at 19.51 and were told that immediate clinical intervention was needed, but the agreed hospital to hospital transfer pathway was not followed. There was a two hour delay in ambulance attendance, during which time Mrs Hollis continued to deteriorate. Mrs Hollis was subsequently taken to the High Dependency Unit at the Norfolk and Norwich University Hospital where her condition continued to deteriorate and she died in the early hours of the 23 February 2022.
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Content ArticlePotentially serious complications occurred in 1 in 18 procedures under the care of an anaesthetist in UK hospitals, according to a national audit by the Royal College of Anaesthetists (RCA). Risks were found to be highest in babies, males, patients with frailty, people with comorbidities, and patients with obesity. Risks were also associated with the urgency and extent of surgery and procedures taking place at night and/or at weekends. The survey, published in Anaesthesia, was the RCA's seventh national audit project (NAP7) and included more than 20,000 procedures at over 350 hospital sites. NAPs study rare but potentially serious complications related to anaesthesia, and are intended to drive improvements in practice. Each focuses on a different topic and NAP7 examined perioperative cardiac arrest. Dr Andrew Kane, consultant in anaesthesia at James Cook University Hospital in Middlesbrough and a fellow at the RCA's Health Services Research Centre in London, said the new data presented "the first estimates for the rates of potentially serious complications and critical incidents observed during modern anaesthetic practice". The data confirmed that individual complications are uncommon during elective practice, but highlight the relatively higher rate of complications in emergency settings.
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Content ArticleThe Greater Manchester Major Trauma Network recognise that many older patients self-present to emergency departments and the ‘Meet Harry’ infographic was produced as an aide memoire to triage nurses and clinicians to assist in assessment. You can view the ‘Meet Harry’ infographic by clicking on the image or download it from the attachment below.
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Content ArticleDisruptive behaviours have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events. This study assessed the status of disruptive behaviours and staff relationships in the ED setting. It concluded that disruptive behaviours in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognise the significance of disruptive behaviours and implement appropriate policies and protocols to address this issue.
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Content Article'Gridlock' of patients in urgent and emergency care is often attributed to a lack of onward capacity for people leaving hospital, leading to delayed discharges that back up the system. But does this explanation often favoured by government and policy makers tell the whole story? The Nuffield Trust's Quality Watch investigates whether the pattern is visible in patient journeys through urgent and emergency care at the integrated care system level.
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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.
