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Showing results for tags 'Emergency medicine'.
Found 372 results
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News Article
Take car in emergency during 999 strike, says cabinet minister
Patient Safety Learning posted a news article in News
Patients should “make their own way to hospital” if they can do so during Wednesday’s strike by ambulance workers, a cabinet minister said yesterday, as the government warned that the industrial action would put lives at risk. Senior government figures said that ambulance unions had still not agreed national criteria for what conditions would be considered life threatening and responded to during the strike. Steve Barclay, the health secretary, is understood to be writing to all striking unions, including nurses, seeking discussions on patient safety. Yesterday Oliver Dowden, the Cabinet Office minister, said people should still call 999 in an emergency but might in less serious cases have to make their own way to hospital. “We are working to ensure that if you have a serious injury, in particular a life-threatening injury, you can continue to rely on the ambulance service, and we would urge people in those circumstances to dial 999,” he told Sunday with Laura Kuenssberg on BBC1. “If it is the case that you have less serious injuries, you should be in touch with 111, and you should seek to make your way to hospital on your own if you are able to do so.” Read full story (paywalled) Source: The Times, 19 December 2022 -
News Article
Emergency patients staying an extra day in ‘congested’ hospitals
Patient Safety Learning posted a news article in News
Patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid, consuming millions of additional ‘bed days’, HSJ analysis has found. The finding explains in part why fewer people are being treated in hospitals, but more resources are being consumed to do so. This has prompted concerns about an apparent big drop in productivity. NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”. Read full story (paywalled) Source: HSJ, 19 December 2022 -
News Article
Republic of Ireland: 'Unsafe' A&Es criticised as doctors warn of GP crisis
Patient Safety Learning posted a news article in News
Patients are not safe from harm in three out of seven emergency departments, a damning new Hiqa inspection report has revealed. The report was released on the same day as an Oireachtas committee was warned of a growing crisis in primary care, with patients in some parts of the country unable to access basic GP services. Emergency Departments in Cork University Hospital (CUH) and University Hospital Limerick (UHL) were among seven EDs assessed by the health watchdog. In three EDs, including Cork and Limerick, inspectors found failures to ensure “service providers protect service users from the risk of harm.” Inspectors also found patients’ “dignity, privacy and autonomy” was not respected in UHL, while CUH was only partially compliant in this area. The report also highlighted lengthy waiting times, including one patient who spent 116 hours on a trolley at UHL. Read full story Source: The Irish Examiner, 15 December 2022 -
News Article
ER doctors in the US misdiagnose patients with unusual symptoms
Patient Safety Learning posted a news article in News
As many as 250,000 people die every year because they are misdiagnosed in the emergency room, with doctors failing to identify serious medical conditions like stroke, sepsis and pneumonia, according to a new analysis from the US federal government. The study by the Agency for Healthcare Research and Quality estimates roughly 7.4 million people are inaccurately diagnosed of the 130 million annual visits to hospital emergency departments in the United States. Some 370,000 patients may suffer serious harm as a result. Researchers from Johns Hopkins University analysed data from two decades’ worth of studies to quantify the rate of diagnostic errors in the emergency room and identify serious conditions where doctors are most likely to make a mistake. While these errors remain relatively rare, they are most likely to occur when someone presents with symptoms that are not typical. “This is the elephant in the room no one is paying attention to,” said Dr. David E. Newman-Toker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence, and one of the study’s authors. The findings underscore the need to look harder at where errors are being made and the medical training, technology and support that could help doctors avoid them, Dr. Newman-Toker said. “It’s not about laying the blame on the feet of emergency room physicians,” he said. Read full story Source: New York Times, 15 December 2022 -
News Article
Ambulance strike threatens ‘different magnitude of risk’
Patient Safety Learning posted a news article in News
The ambulance staff strike next week represents a far higher risk to patient safety and services than the nurses’ strike, but a blanket elective ban will only be used as “an absolute last resort”, a senior NHS England director said today. However, NHSE elective recovery chief Sir Jim Mackey’s comments come despite several local leaders telling HSJ significant amounts of elective activity are likely to need to be postponed due to the ambulance staff walkout on 21 and 28 December, to free up capacity to deal with emergency care pressure. Speaking at a King’s Fund conference this morning, Sir Jim said: “The ambulance strike is a completely different order of magnitude of risk [than the nurses’ strike]. I think that’s the main thing people are worried about because of the complexity and fragility of urgent care.” However, he added: “If we were to give [national guidance on what elective activity to cancel] today, the only guidance we could give would be to cancel absolutely everything, and that’s really not going to help anybody… “I think we’ll just have to take it day-by-day and keep learning from each other and sharing intelligence… and then, if at some point, there is a case for blanket order, we’ll consider that… But, we really want to do that as an absolute last resort.” Read full story (paywalled) Source: HSJ, 15 December 2022 -
News ArticleVulnerable patients, including some children, have faced long delays for a suitable bed as organisations argue over whose responsibility it is to fund and deliver their care, HSJ understands. In a letter outlining winter arrangements, NHS England has warned trust leaders and commissioners against delaying emergency mental health admissions – typically needed when a patient is away from home, and understood to be more common over the Christmas period – while determining which area has which responsibility. National mental health director Claire Murdoch wrote: “It is not acceptable to delay an emergency mental health admission while determining which area has clinical and financial responsibility for the care of an individual.” She added such admissions should be arranged “as quickly as possible, and without delay caused by any financial sign-off process”. It comes as HSJ has been told patients can often end up waiting for several days in emergency departments or in “inappropriate” out of area or acute beds when disputes occur over who is responsible for their care. Read full story (paywalled) Source: HSJ, 15 December 2022
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News ArticleMedics and nurses have been urgently called upon to support London Ambulance Service during next week’s strike action, as it will otherwise have to rely on staff only able to provide ‘first aid’. The North East London primary care team has sent out a request for clinical staff working for integrated care boards to be released from duties ahead of industrial action on 21 December. Unison members are preparing to walk out, alongside thousands of other staff at nine other ambulance trusts across the country, in a dispute over pay. The letter, seen by HSJ, was sent yesterday afternoon. It said: “LAS are keen to have experienced medics and nurses, who have current urgent and emergency clinical exposure, have knowledge of how to navigate the system and can operate as a senior clinical decision maker. Medical Practitioners would ideally be from general practice and emergency medicine. “Advanced Paramedics and Advanced Care Practitioners with urgent care or IUC CAS experience are also required. A knowledge of ambulance services is preferred as it removes the need to learn very quickly the significant differences in ambulance services and LAS control rooms." Read full story (paywalled) Source: HSJ, 13 December 2022
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News Article
'Multiple systemic failures' found at Royal Infirmary of Edinburgh A&E
Patient Safety Learning posted a news article in News
Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh. Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March. The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway. The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections. At the time of the inspection, the emergency department was on some days operating at over three times its capacity. The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. Read full story Source: The Herald, 18 May 2023 -
News Article
Artificial intelligence could ‘transform’ heart attack diagnosis, scientists say
Patient Safety Learning posted a news article in News
Artificial intelligence (AI) could be “transformational” in improving heart attack diagnosis to reduce pressure on emergency departments, a new study suggests. Doctors could soon use an algorithm developed using AI to diagnose heart attacks with better speed and accuracy than ever before, the research from the University of Edinburgh indicates. It could also help tackle dangerous inequalities in diagnosing the condition, scientists suggest. Researchers found that, compared to current testing methods, the algorithm called CoDE-ACS was able to rule out a heart attack in more than double the number of patients, with an accuracy of 99.6%. Nicholas Mills, British Heart Foundation (BHF) professor of cardiology at the Centre for Cardiovascular Science, University of Edinburgh, who led the research, said: “For patients with acute chest pain due to a heart attack, early diagnosis and treatment saves lives. “Unfortunately, many conditions cause these common symptoms, and the diagnosis is not always straight forward. “Harnessing data and artificial intelligence to support clinical decisions has enormous potential to improve care for patients and efficiency in our busy emergency departments.” Read full story Source: The Independent, 11 May 2023 -
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
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News Article
Critically ill patients ‘will inevitably die’ due to junior doctors’ strike
Patient-Safety-Learning posted a news article in News
Critically ill patients “will inevitably die” because hospitals are having to cancel surgery as a direct result of next week’s junior doctors’ strike in England, leading heart experts have warned. There were bound to be fatalities among people with serious heart problems whose precarious health meant they were “a ticking timebomb” and needed surgery as soon as possible, they said. They added that patients would face an even greater risk than usual of being harmed or dying if their time-sensitive operation was delayed because NHS heart units would have too few medics available during the four-day stoppage by junior doctors to run normal operating lists. The trio of cardiac experts are senior doctors at the Royal Brompton and Harefield specialist heart and lung hospitals in London. Those facilities, plus the cardiac unit at St Thomas’ hospital in the capital, have between them postponed between 30 and 40 operations they were due to conduct next week on “P2” patients, whose fragile health means they need surgery within 28 days. “It is no exaggeration to say that delaying surgery for this group [P2s] will result in harm. For some, this may be life-changing. For others, it may mean premature death,” said Dr Richard Grocott-Mason, a cardiologist who is also the chief executive of the Royal Brompton and Harefield hospitals. Read full story Source: The Guardian, 4 April 2023 -
News Article
England's new ambulance numbers not 800 promised, figures show
Patient-Safety-Learning posted a news article in News
The number of new ambulances in England will be far less than the hundreds promised by the government, a Freedom of Information request has revealed. In January, 800 new ambulances were announced, with a 10% fleet increase. But vehicles being ordered by trusts are mostly replacements they were prevented from purchasing because of procurement changes and the pandemic. In response to a written question in February, DHSC said the "over 800 new ambulances" advertised equated to about 350 extra vehicles, plus 100 mental health ambulances. However, the FOI responses from England's ambulance trusts suggest the number of extra vehicles will be far fewer. Read full story Source: BBC News, 4 April 2023 -
News Article
Thousands of English NHS 999 calls answered in Wales
Patient Safety Learning posted a news article in News
Thousands of 999 calls are being transferred to the Welsh Ambulance Service because they are taking more than five minutes to answer in England, HSJ can reveal. More than 50,000 calls – 1.2% of all made – were sent to a different ambulance service than the one intended between October and the middle of February, under a new system of routing unanswered calls was introduced. It automatically diverts calls which have not been answered after five minutes, rerouting them to services with current capacity, while a BT operator remains on the line until the call is answered. The Welsh Ambulance Service explained it records details from the transferred caller, prioritises the response level and provides lifesaving instructions if required, including having access to a national database of defibrillators. However, it is unable to despatch ambulances outside its area and does not provide clinical assessment. Instead the details are transferred electronically into the “home” trust’s computer-aided despatch system. Read full story (paywalled) Source: HSJ, 21 March 2023 -
News Article
Patients ‘unaware of strike’ as some hospitals report ‘busiest day’
Patient Safety Learning posted a news article in News
Acute trusts are reporting high demand at emergency departments (EDs) despite junior doctor strikes, which in some cases threaten to lead to overflowing wards and long ambulance handover delays. Chief executives and directors from trusts around England told HSJ their EDs had been as busy or busier than usual. Many had hoped prominent media coverage and NHS announcements about the strikes would lead to reduced demand, helping them cope with fewer doctors on duty. Several claimed it showed national communications about the strikes were lacking. NHS England has said some hospitals saw their busiest Monday of the year so far yesterday, which it said “presents a major challenge as our staff continue to do all they can to mitigate the impact of the industrial action for patients.” Read full story (paywalled) Source: HSJ, 14 March 2023 -
Content ArticleA BBC Newsnight investigation hears devastating evidence and testimony of ambulance failings in the north east of England. What does it take to run a safe service that patients can trust?
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Content ArticleOn 24 May 2022, Mrs Brind went to see her GP and was taken to Queen Elizabeth Hospital arriving at 13.05 hours. The Emergency Department was busy and Mrs Brind remained on the ambulance. Physiological observations were undertaken at 12.50, 13.24 and 13.53 which showed an elevated NEWS2 score. Mrs Brind required increasing oxygen which was not escalated to the ambulance navigator at the hospital, no further physiological observations were undertaken and no ECG was undertaken. Mrs Brind was taken to the ward at 17.30 hours, when she became agitated and short of breath. Advanced life support was put into place but Mrs Brind’s condition continued to deteriorate and she died at 17.52 hours.
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Content ArticleNHS England recently published its Delivery Plan for Recovering Urgent and Emergency Care Services, with goals and actions for the next two years. David Oliver, consultant in geriatrics and acute general medicine, gives his opinion on the plan.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Rob talks to us about his passion for using human factors to improve safety in emergency departments, how allowing doctors to choose their own shifts can make staffing safer and how better integrating technology could help doctors diagnose and treat patients more safely and effectively. -
Content ArticleQuality improvement is a methodology used routinely in emergency departments (EDs) to bring about change to improve outcomes such as waiting times, time to treatment and patient safety. However, introducing the changes needed to transform the system in this way is seldom straightforward with the risk of “not seeing the forest for the trees” when attempting to make changes. This article in Annals of Emergency Medicine aims to demonstrate how the functional resonance analysis method can be used to capture the experiences and perceptions of frontline staff to identify the key functions in the system (the trees), to understand the interactions and dependencies between them to make up the ED ecosystem (“the forest”) and to support quality improvement planning, identifying priorities and patient safety risks.
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Content ArticleThese prompt cards were developed by a team at University Hospitals Sussex NHS Foundation Trust to assist emergency department teams in dealing with: medical emergencies trauma transfers and briefings anaesthetics and resuscitation procedures medications clinical scores.
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Content ArticleThis investigation by the Healthcare Safety Investigation Branch (HSIB) aims to improve patient safety by supporting staff to access critical information about patients at their bedsides in emergency situations. It defines critical information as ‘information about patients that needs to be accessed rapidly and accurately to ensure correct care is delivered when it is required’. In this investigation, critical information was considered through a focus on patient identifiers (such as name and date of birth) and decisions relating to whether someone is recommended to receive cardiopulmonary resuscitation (CPR) if their heart stops (cardiac arrest). The reference event for this investigation was the care of a patient in a hospital who was found unresponsive in bed. A short time later, he stopped breathing and his heart stopped. Help was immediately sought from the ward staff and a team gathered around the patient’s bed, where they confirmed the patient’s identity and noted that a decision had been made that he was not recommended to receive CPR if his heart stopped. As a result, CPR was not started. Around 10 minutes later, a nurse who had previously been caring for the patient returned from their break and recognised that the patient had been misidentified as the patient in the next bed. The patient whose heart had stopped was recommended to receive CPR. CPR was immediately started, but despite this, the patient died.
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Content Article
The Psychologically informed policy and practice development (PIPP) project investigated current workplace concerns, barriers to change and opportunities for development and growth, and was a collaborative project run by the Royal College of Emergency Medicine, UK Research and Innovation and the University of Bath. This document details specific evidence-based recommendations relating to four key areas identified as prioritised targets in emergency care workforce development: An environment to thrive in Cultivating a better culture A tailored pathway of care Enhanced leadership The recommendations are detailed, supported by evidence, existing guidelines and new empirical data, and are specific to the needs of the emergency care specialty. -
Content ArticleTo support recovery of the NHS by improving waiting times and patient experience, a joint Department of Health and Social Care (DHSC) and NHS England plan sets out a number of ambitions, including: Patients being seen more quickly in emergency departments: with the ambition to improve to 76% of patients being admitted, transferred or discharged within four hours by March 2024, with further improvement in 2024/25. Ambulances getting to patients quicker: with improved ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24, with further improvement in 2024/25 towards pre-pandemic levels. NHS England has engaged with a wide range of stakeholders to develop the plan, and it draws on a diverse range of opinion and experience, as well as views of patients and users. The Department of Health and Social Care, who produced the content on actions being taken in social care, have led on engagement with the sector.
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Content ArticleThe Royal College of Emergency Medicine (RCEM) ‘Wales' Emergency Medicine Workforce Census 2023’ is an in-depth analysis of the state of the Emergency Medicine workforce, providing an insight into the working patterns of clinicians and allowing a forecast to be made around the future workforce needs of Emergency Departments in Wales.
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Content ArticleThis video shows CCTV footage of Bob being treated for a cardiac arrest on his way to watch a football match at the AMEX stadium in Brighton. The video could be used as a training tool to show how to start cardiopulmonary resuscitation (CPR) and how to use an automated external defibrillator (AED). The video highlights what the AED is analysing and then shocking, showing what happened to the electrical rhythm as it converts ventricular fibrillation (VF) to sinus rhythm. It also features the voice prompts from the cardiac arrest. Bob survived with a completely normal quality of life and was the seventh person (out of seven) at the AMEX stadium to have a cardiac arrest and survive with a normal quality of life. The video shows great team work and human factors interactions between the St John Ambulance volunteers who saved Bob's life, the stewarding team and paramedics.
