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Found 373 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. 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
  3. 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
  4. 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.
  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. News Article
    The NHS has lost almost 25,000 beds across the UK in the last decade, according to a damning report says the fall has led to a sharp rise in waiting times for A&E, ambulances and operations. The Royal College of Emergency Medicine said the huge loss of beds since 2010-11 was causing “real patient harm” and a “serious patient safety crisis”. At least 13,000 more beds are urgently needed, it added, in order to tackle “unsafe” bed occupancy levels and “grim” waiting times for emergency care and handover delays outside hospitals. Patients are increasingly “distressed” by long waiting times, the college said, as are NHS staff who face mounting levels of burnout, exhaustion and moral injury. The UK has the second lowest number of beds per 1,000 people in Europe at 2.42 and has lost the third largest number of beds per 1,000 population between 2000 and 2021 (40.7%), the report said. There are currently 162,000 beds in the NHS across the UK, according to the college. “The situation is dire and demands meaningful action,” said Dr Adrian Boyle, the college’s vice-president. “Since 2010-11 the NHS has lost 25,000 beds across the UK, as a result bed occupancy has risen, ambulance response times have risen, A&E waiting times have increased, cancelled elective care operations have increased. “These numbers are grim,” Boyle added. “They should shock all health and political leaders. These numbers translate to real patient harm and a serious patient safety crisis. The health service is not functioning as it should and the UK government must take the steps to prevent further deterioration in performance and drive meaningful improvement, especially ahead of next winter.” Read full story Source: The Guardian, 31 May 2022
  17. News Article
    Dozens of patients died or suffered ‘severe harm’ after long waits for ambulances during a three-month period in a health system facing ‘extreme pressure’ on its emergency services. The 29 serious incidents in Cornwall included patients waiting many hours for assistance despite being in “extreme pain”, patients having suspected sepsis, patients in cardiac arrest, and patients experiencing a stroke. The incidents were reported to the Care Quality Commission by staff at South Western Ambulance Service Foundation Trust during an inspection of the Cornwall integrated care system’s urgent and emergency care services. According to the CQC, the pressures on the ambulance service were “unrelenting”, while “significant work” was needed to “alleviate extreme pressure”. This meant there was a “high level of risk to people’s health when trying to access urgent and emergency care in the county”, the report said. Read full story (paywalled) Source: HSJ, 27 May 2022
  18. News Article
    A clinical director and several senior managers have written to a trust CEO warning that patients are routinely waiting more than 60 hours to be admitted to a ward from accident and emergency, leaving staff “crying with frustration and anger”. In a letter to executives at Lancashire Teaching Hospitals Foundation Trust, seen by HSJ, the managers say they lack support from the rest of the trust, and claim the emergency department at Royal Preston Hospital has a “never-ending elasticity in the eyes of others”. The letter, dated 30 March, is signed by clinical director Graham Ellis, two unit managers, the specialty business manager, and the matron. It says: “Whilst we have documented our concerns previously the current situation is worse than it has ever been…Our situation is increasingly precarious… “For the past few months we have on a regular basis had more than 50 patients waiting for a bed and that wait being in excess of 60 hours. “This means that at most times there is limited or no space to accommodate newly acutely ill patients causing ambulance handover delays of over four hours and delay in treatment.” Clinicians at Preston have been raising safety concerns about the ED for several years, but the letter is the first time concerns of senior managers have been made public. The letter references research which suggests patients die as a “direct result from long waits in ED”, and says there has been an increase in clinical incidents, pressure sores, detrimental outcomes, and occasions where patients “die without the dignity of privacy”. Read full story (paywalled) Source: HSJ, 4 April 2022
  19. News Article
    NHS leaders are warning that the health service is facing the "brutal reality" of an Easter as bad as most winters. Latest data shows record waits for planned surgery and in A&E, as staff plough through a backlog fuelled by Covid. The government says there is hope on the horizon. Jean Shepherd, 87, had a stroke in April last year, leaving her severely disabled and requiring round-the-clock care. At the end of February there was an outbreak of sickness at her nursing home and she needed hospital treatment. She had to wait in a wheelchair for more than 9 hours until an ambulance arrived to take her to A&E. She then spent 31 hours on a trolley between the emergency department and a secondary-care unit. "She was very distressed because she doesn't like hospitals at the best of time," says her son, Andy Shepherd. "Since the stroke, because of her cognitive ability, she doesn't understand what's happening around her." Mrs Shepherd was eventually moved to a bed in a main hospital ward, where her family says she later contracted Covid, before recovering and being discharged back to her care home two weeks later. "I appreciate that A&E departments have always been busy, but I just wasn't prepared for what greeted me at the hospital," says her son. "There were patients on ambulance trolleys literally everywhere and the staff were absolutely rushed off their feet. I remember thinking at the time that this is not sustainable." Read full story Source: BBC News, 14 April 2022
  20. News Article
    An ambulance service has raised concerns over the record number of ‘hours lost’ to handover delays at an acute hospital on its patch, which it says is happening despite the number of arrivals being at its lowest level in seven years. West Midlands Ambulance Service University Foundation Trust has said the situation at Royal Stoke Hospital presents a “significant risk to patient safety”, but “we don’t currently see actions being taken that are reducing this risk”. It comes amid rising frustrations from ambulance chiefs around the country at a perceived lack of support from acute hospitals around handover delays. Ambulance response times for some of the most serious 999 calls have ballooned in recent months, in part due to lengthy handover delays at emergency departments. In a letter sent to a member of the public on 31 March, Mark Docherty, director of nursing at WMAS, said: “WMAS [is] experiencing difficulties as a direct result of delays in patient handovers at acute hospitals. We have been highlighting our concerns for over six years as the situation has become progressively worse every year." Read full story (paywalled) Source: HSJ, 10 April 2022
  21. News Article
    Patients visiting Wales' newest emergency department were likely to have been put at risk of harm due to the lack of processes and systems in place, inspectors found. Healthcare Inspectorate Wales (HIW) carried out an unannounced inspection of The Grange University Hospital in Cwmbran between 1 and 3 November last year and published its findings on 29 March. On the day of their arrival inspectors said The Grange was at full capacity with no empty beds in A&E or in the hospital in general. Despite the best efforts of staff who were "working hard under pressure" the report stated the emergency department had several issues which could have compromised the privacy and dignity of patients. This included problems with the physical environment of the waiting room, which was described as a "major cause of anxiety" for visitors, as well as with the flow of patients through the hospital in general. It found that patients were not triaged and medically managed in A&E in a timely fashion with many being placed on uncomfortable chairs or in corridors for hours on end. Between 1 April 2021 and 1 November 2021, the average waiting time in the department was six hours and seven minutes. The report said some issues required immediate action including the fact patients in the waiting area were often left to "deteriorate without being overseen". There were also infection control failures which could have led to the cross-contamination of Covid-19. "We were not assured that all the processes and systems in place were sufficient to ensure that patients consistently received an acceptable standard of safe and effective care," the report stated. Read full story Source: Wales Online, 1 April 2022
  22. News Article
    Stroke and heart attack victims are now routinely waiting more than an hour for an ambulance, after a further fall in performance in recent weeks, and with hospital handover delays hitting a new high point, HSJ reveals. Figures for ambulance performance this week, seen by HSJ, showed average response times for category two calls at more than 70 minutes for successive days. 3,000 patients may have suffered “severe harm” from delays in February, ambulance chief executives say. Several well-placed sources in the sector said response times had deteriorated further this month, and that more than half of ambulance trusts were this week seeing average category two responses of longer than an hour. Some cited an average category two response last week of around 70 minutes, with the services under huge pressure from a combination of demand, long handover delays, and covid-related sickness. Category two calls include patients with suspected heart attacks and strokes, and the national target for reaching them is 18 minutes. The figures seen by HSJ for this week showed average response times for category one calls — the most serious, including cardiac arrests and other immediately life threatening emergencies — of more than 10 minutes on Wednesday, against a target of just 7 minutes. Monthly average performance for category one has never reached 10 minutes. Read full story (paywalled) Source: HSJ, 1 April 2022
  23. News Article
    The Royal College of Emergency Medicine (RCEM) estimated 36 Scots died as a direct result of avoidable delays in the week to 30 March. It comes as the number of people in hospital with Covid reached another record high, the worst cancer waiting times were reported since records began in 2006, and the Royal College of Nursing issued a warning that patient care is under “serious threat” from record-high staffing shortages. The RCEM said it would “welcome” a decision to extend the legal requirement to wear face coverings in Scotland to protect the NHS. “Anything that can continue to reduce the spread and therefore try and relieve as much pressure as possible in the healthcare system would be welcomed,” said RCEM Vice President in Scotland Dr John Thomson. Dr Thomson, an emergency medicine consultant at Aberdeen Royal Infirmary, said the government must understand the “unconscionable” harm coming to patients. “We have clear evidence that prolonged weeks in an emergency department lead directly to patient deaths,” he said. “Good evidence that, irrespective of what the medical problem is that they present with, that long wait alone is associated with death. “We can measure that quite clearly. One in 72 patients who wait in an emergency department beyond eight hours will die as a direct result. “In the last week alone we would estimate there were 36 avoidable deaths due to waits beyond eight hours. That's unconscionable.” A&E’s in Scotland are facing the “biggest patient safety crisis for a generation”, he said. Read full story Source: The Scotsman, 29 March 2022
  24. News Article
    NHS England’s plan to make the 111 service a ‘primary route’ into emergency departments has fallen ‘far short of aspiration’, with only a small fraction of attendances being booked through it. NHSE began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”. Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70% of patients referred to ED by 111 services should receive a booked time slot to attend. Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected. Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking. Jacob Lant, head of policy and research at Healthwatch England, said: “Sadly, it’s clear from these figures that implementation across the country is lagging behind where we would have hoped. “Obviously this has to be seen in the context of the massive pressures on A&E departments at the moment as a result of the pandemic, but there is also a need for the NHS to really step up efforts to tell people about this new way of accessing care.” Read full story (paywalled) Source: 25 February 2022
  25. 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
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