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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 -
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 ArticlePhysicians raised a concern to the Quality Department about patients who were diagnosed in the emergency department (ED) with a urinary tract infection (UTI) but who later were clinically reviewed and found to be without disease. These patients were often admitted and treated with potentially unnecessary antibiotics.
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Content ArticleAdherence to best practices for sepsis management at a small community hospital was below system, state and national benchmarks and affected vital indicators, including mortality. This study carried out by Megan Kiser aimed to improve sepsis best practice compliance by implementing human factors–influenced interventions.
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Content ArticleThe Royal College of Emergency Medicine (RCEM) commissioned Ipsos to conduct an online poll of UK adults aged 16-75 to better understand their views on emergency care. The poll revealed that confidence in the UK Government’s approach to tackling long waits for patients in A&E is low, with 59% of respondents expressing a lack of confidence that the UK Government has the right policies to tackle long patient waiting times in A&E departments in hospitals. RCEM’s five priorities below for UK Governments will #ResuscitateEmergencyCare to ensure the emergency care system is there for us all in our time of need.
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Content ArticleIn this article, published by Inflect Health, ER doctor Josh Tamayo-Sarver explains what happened when he asked artificial intelligence chatbot ChatGPT to provide possible diagnoses based on his case notes.
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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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Content ArticleThis letter to NHS mental health trusts, Integrated Care Boards and Commissioners outlines NHS England's position on the use of Serenity Integrated Mentoring (SIM) in NHS mental health services. SIM is a model of care that has been used with people with mental health issues who are considered high-intensity users of emergency services. It is a controversial approach as it instructs services providing emergency care not to provide support to these individuals.
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Content ArticleIn this Channel 4 Dispatches programme, secret footage filmed over the winter reveals ambulance workers battling the odds and A&E departments overwhelmed as patients suffer needless harm and death The footage comes from Daniel Waterhouse, an emergency medical technician who wore a body-mounted camera during his shifts in north-west London for three months this winter, filming every crumbling layer of a system that is close to total destruction.
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Content ArticleMedication errors are an important cause of preventable morbidity, especially in children in emergency department (ED) settings. Internal use of voluntary incident reporting (IR) is common within hospitals, with little external reporting or sharing of this information across institutions. In this paper published Emergency Medicine Journal, authors describe the analysis of paediatric medication events (ME) reported in 18 EDs in a paediatric research network in 2007–2008.
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Content ArticleIn this on-demand webinar, professionals across the NHS discuss how their speciality areas interact with urgent care, and how digital health can be used to relieve pressure in relevant areas. Speakers: Dr Tom Micklewright, Medical Director at ORCHA and NHS GP Helen Hughes, Chief Executive at Patient Safety Learning Chris Efford, Clinical Lead Physiotherapist and Digital Fellow, University Hospitals Dorset and DNHS Dorset Digital Services at Home Team Dr Simon Leigh, Health Economist and Director of Research, ORCHA View presentation slides from the webinar
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Content ArticleTension pneumothorax can occur following chest trauma, respiratory disease and infection, or during resuscitation requiring invasive or non-invasive ventilation. It is a life-threatening condition resulting from a collapsed lung when air trapped in the pleural cavity compromises cardiopulmonary function. Immediate temporary decompression is required to prevent cardiac arrest. This is commonly done by inserting a needle and cannula, usually used for intravenous access, through the chest wall into the pleural cavity (needle thoracostomy). The needle is withdrawn, and the cannula left in place to allow the trapped air to flow out. New blood control (closed system) intravenous cannulas are increasingly used in the NHS; at least 130 trusts bought a total of three million of them in the last year. They look very similar to both traditional and standard safety cannula (with needle guard or shield) but have an extra integral septum which closes when the needle is withdrawn and stops free flow in or out of the cannula. Flow is only possible once an intravenous line or Luer-lock syringe is attached to the hub, which opens the septum. Blood control (closed system) cannulas help prevent blood spillage, exposure and contamination, when used for their intended intravenous purpose, but they cannot be used to decompress a pneumothorax without additional equipment. The main patient safety risks are: staff may select a blood control (closed system) cannula not realising its limitations for this procedure a blood control (closed system) cannula may wrongly be assumed to be functioning in a patient who is deteriorating rapidly a second needle might be introduced risking very significant damage to the lung as it reinflates.
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Content ArticleEmergency care services in the UK face an unparalleled crisis, with more patients than ever before experiencing extremely long waiting times in Emergency Departments (EDs), associated with patient harm and excess deaths. This explainer from the Royal College of Emergency Medicine (RCEM) outlines the latest data on ED waiting times and the impact this is having on patient safety.
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Content ArticleWith the NHS often characterised as being trapped in a permacrisis, what can be done to shift the dial? In this NHS Confederation podcast, Daniel Elkeles, chief executive of the London Ambulance Service NHS Trust, talks about improvements in the urgent and emergency care pathway, shifting the narrative on primary care and busting the barriers holding the health and care system back. With industrial action taking a toll, Daniel, who leads the world’s largest ambulance service, sheds light on the untold impact of strikes, the effect on long-term innovation and recovery and why culture change in the ambulance service is top of his mission list.
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Content ArticleThe new NHS recovery plan accepts that data on long delays in emergency departments must be published monthly to help improve patient care and hold systems to account, writes Katherine Henderson in this BMJ opinion piece.
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Content ArticleThe Healthcare Safety Investigation Branch (HSIB) have published a third interim report for this investigation which focuses on staff wellbeing across the urgent and emergency care systems and the impact that this has on patient safety.
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News ArticleMore than 200 people who died last week in England are estimated to have been affected by problems with urgent and emergency care, according to the president of the Royal College of Emergency Medicine. Dr Adrian Boyle, who is also a consultant in emergency medicine, told BBC Radio 4’s Today programme that a failure to address problems discharging patients to social care was a “massive own goal”. Ambulances had become “wards on wheels” while patients waited to get hospital treatment, Boyle said, adding that those most at risk “are the people that the ambulance can’t go to because it’s stuck outside the emergency department”. His comments came as the NHS launched 42 “winter war rooms” across England, designed to use data to respond to pressures on the health system. When asked about the project, Boyle said it was too early to tell if it was a good idea, adding: “You can paralyse yourself with analysis, it really is actually more simple and about building increased capacity.” He said the problem was best solved by focusing on hospital discharge and social care. “Fixing this starts at the back door of the hospital and being able to use our beds properly,” he said. “At the moment, there are 13,000 people waiting in hospitals, about 10% of the bed base, who are waiting to be discharged either to home, with a little bit more support, or to a care facility. And that’s just a massive own goal. We just need to reform the interface between acute hospitals and social care.” Read full story Source: The Guardian, 1 December 2022
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News ArticleA Northern Ireland hospital closed its doors to new admissions on Saturday night because conditions had become unsafe, a health chief has said. Jennifer Welsh, chief executive at the Northern Health Trust, said the situation in the emergency department (ED) at Antrim Area Hospital on Monday remained “extremely pressured”. A major incident was declared at the weekend when a high number of critically ill patients arrived in quick succession at the Co Antrim hospital, prompting the decision to temporarily close the doors to new admissions. Ms Welsh said there were 45 patients in the ED on Monday for whom a decision to admit had been made, but for whom no bed is available. She told the BBC Good Morning Ulster programme: “That would have been unthinkable about four or five years ago, we would have never seen numbers like that." She said: “We had a high number of people arriving. A very high number of patients in the department. “At the time we called the incident there were 131 patients and about 66 of them had a decision to admit and no bed available. “At that stage our resuscitation unit was already full, it was over full. “Then we got the news we had three more standby ambulances coming in. That is critically ill patients who had to be brought into our resuscitation department as quickly as possible and we simply could not cope. “The safest thing to do in those circumstances is to call the major incident, to effectively close the door and what that means is that people are conveyed to the next nearest emergency department to ensure they begin the urgent treatment that they need because we were not able to do that. “It was the right call to say that it was unsafe. It was unsafe at that time.” Read full story Source: The Independent, 14 November 2022
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News ArticleAmbulances called to serious emergencies in the East of England, which encompasses Essex, have the longest waiting times of anywhere in the UK, according to new data. The East of England Ambulance Service, which serves the county of Essex, has the longest wait times for life-threatening injuries of anywhere in the country. Ambulances took an average of 11 minutes and 12 seconds to respond to category one calls - those for life threatening injuries - in the Essex region in October. That’s up from 10 minutes 49 seconds in September, and far longer than the 7 minute target set by the NHS. This means it’s also the longest category one response time of any ambulance service in England, as compared to the average wait time for ambulances across England as a whole, category one calls were responded to in an average of 9 minutes and 56 seconds. A spokesperson for the East of England Ambulance Service said: "Our service is under extreme pressure with many ambulances delayed outside hospitals and high call volumes. "To help us respond effectively we have increased our escalation state across the Trust. We urge the public to please support us by using our services wisely and only calling for life-threatening illnesses and injuries." Read full story Source: Essex Live, 10 November 2022
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News ArticleThe South East Coast Ambulance Service declared a Critical Incident last night. The NHS Foundation Trust - which serves Kent, Surrey, West Sussex and East Sussex and part of north-eastern Hampshire around Aldershot, Farnborough, Fleet and Yateley - is urging the public to only call 999 in a 'serious emergency'. This is because of IT issues which have resulted in the loss of its Computer Aided Dispatch (CAD) system. In a statement issued on social media at around 9pm, the Ambulance Service said: "We have tonight (10 November) declared a Critical Incident following IT issues which resulted in the loss of our CAD (Computer Aided Dispatch) and the need to move to our back-up telephone systems. "While we are working hard with our IT providers to find a solution to the issue, and have implemented well-rehearsed contingency plans, the loss of the CAD, along with the high demand we are facing across our region tonight, is placing significant pressure on our services. "We continue to answer calls and respond to patients but urge people to only call 999 in the event of a serious emergency and to make use of services, including NHS 111 Online, for help and advice. "We would like to thank our staff and volunteers for their hard work and commitment at this challenging time and assure the public that we are doing everything we can to resolve the issue as quickly as possible." Read full story Source: Kent Live, 10 November 2022
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News Article
US nurse who called emergency services on own hospital speaks out
Patient Safety Learning posted a news article in News
A nurse in the USA who called emergency services in response to staffing issues at Silverdale, Washington-based St. Michael Medical Center spoke out about her decision and the events leading up to the call. Kelsay Irby has been an emergency department charge nurse at the hospital for less than a year. On the 8 October, the night Ms Irby called emergency services for help, the ED was operating at less than 50% of its ideal staffing grid. Among the nearly 50 people in the hospital's waiting room were patients with cardiac or respiratory issues and children with high fevers — "all patients that made us very nervous to have in the lobby, unmonitored for extended periods of time," Ms. Irby said. The ED had one first-look nurse on the clock who was trying to keep up with patients checking in and could not supervise those waiting for care. After exhausting all other available options, Ms. Irby said she called emergency services' nonemergent line and asked the dispatcher if any crews were available to help ED staff. Ms. Irby was connected with a local fire chief who sent an emergency services crew to the hospital to monitor patients in the lobby, retake their vitals and do roll calls to ensure the ED team's patient list was accurate. Ms. Irby's actions made national headlines in the US as a dramatic example of the staffing issues hospitals nationwide are facing. "I didn’t recognize the impact of what I was doing that night," Ms. Irby wrote. "I was simply working my way down the list of possible sources of help for my coworkers and ultimately our patients." Read full story Source: Becker's Hospital Review, 8 November 2022 -
News ArticleThirty-three provider groups in the USA penned a joint letter to President Joe Biden this week warning of “gridlocked” hospital emergency departments that are threatening patients’ lives and the well-being of shorthanded healthcare workers. “In recent months, hospital emergency departments (EDs) have been brought to a breaking point. Not from a novel problem—rather, from a decades-long, unresolved problem known as patient ‘boarding,’ where admitted patients are held in the ED when there are no inpatient beds available,” provider associations including the American College of Emergency Physicians (ACEP) and the American Medical Association (AMA) wrote. “While the causes of ED boarding are multifactorial, unprecedented and rising staffing shortages throughout the healthcare system have recently brought this issue to a crisis point.” The issue of boarding “has become its own public health emergency” for adult and paediatric care alike, the latter of which is being driven by a spike in mental health visits and, more recently, a “triple threat” of flu, COVID-19 and respiratory illnesses that have backed up children’s hospitals. “If the system is already this strained during our ‘new normal,’ how will emergency departments be able to cope with a sudden surge of patients from a natural disaster, school shooting, mass casualty traffic event or disease outbreak?” the groups wrote. The letter included a handful of firsthand accounts solicited by ACEP from anonymous emergency physicians describing patients deteriorating or dying “during their tenth, eleventh or even twelfth hour of waiting to be seen by a physician.” Read full story Source: Fierce Healthcare, 10 November 2022
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News Article
Trusts should seek extra funding to be ready for major incidents, says inquiry
Patient Safety Learning posted a news article in News
Ambulance trusts should review their ability to respond to mass casualty incidents and press commissioners for any additional resources they need, the report into the Manchester Arena bombing has said. Only 7 of the 319 North West Ambulance Service Trust vehicles available on the night of the attack, in 2017, were able to deploy immediately, the report said. It said experts believed that “such a situation would almost inevitably be replicated if a similar incident were to occur again anywhere in the country”, given current resources and demand. Ambulance trusts are now hugely more stretched than in 2017, with response times having significantly lengthened due to lack of resources. The second volume of the report from the inquiry, chaired by Sir John Saunders, published today, is critical of the emergency services’ response to the bombing which killed 22 people. NWAS “failed to send sufficient paramedics into the City Room [an area adjoining the Arena]” and did not use available stretchers to remove casualties in a safe way, it says. A key role for managing the incident – that of ambulance intervention team commander – was not allocated for half an hour. But it also raised issues of ambulance capacity and availability for major incidents involving mass casualties. “Around the UK, ambulance services are always ’playing catch up,’” it said, with no spare frontline capacity. With demand doubling over the last 10 years, the inability to respond to such incidents is only going to get worse – and lives will be lost if they do not attend the scene quickly and in sufficient numbers, the report said. Read full story (paywalled) Source: HSJ, 3 November 2022 -
News ArticleA three-year-old child died after its desperate mother spent more than an hour on hold to the NHS 111 helpline. The ill child suffered a cardiac arrest at its home and died in hospital, according to details of critical incidents affecting children in London amid the coronavirus crisis. Another case saw a six-month-old die from sepsis and liver failure because the parents feared the child could catch Covid-19 in hospital, the Evening Standard reports. Doctors have raised concerns that parents are not seeking treatment for their children amid the outbreak. Read full story Source: 16 April 2020, Mail Online
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Content ArticleAlthough serious medication errors are uncommon, their effects can be devastating for patients and their loved ones. The authors of this study in the journal Patient Safety searched the Pennsylvania Patient Safety Reporting System (PA-PSRS) for reports of serious medication errors in the emergency department from 1 January 2011 to 31 December 2020. They identified trends in the data, looking at patient sex, patient age, event harm score, event day of the week and event time of day. The authors found that: error reports more often specified that the patient was female. events were significantly more likely to happen over the weekend. most errors occurred at the prescribing stage. the most common error type was a wrong dose. They conclude that a number of patient safety strategies could reduce the risk of medication errors in the emergency department, including: stocking epinephrine autoinjectors. using clinical decision support at the ordering/prescribing stage of the process. adding an emergency medicine pharmacist to interdisciplinary emergency medicine teams.
