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Found 50 results
  1. Content Article
    This National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report reviews the quality of care of patients aged 16 and over who had a pulmonary embolism (PE), The study aimed to highlight areas where care could be improved in patients with a new diagnosis of acute PE. A retrospective case note and questionnaire review was undertaken in 526 patients aged 16 and over who had a PE, and who either presented to hospital or developed a PE whilst an inpatient for another condition. You can view and download the following documents: Full report Summary report Summary sheet Recommendation checklist Infographic Slide set Commissioners' guide Fishbone diagram Audit toolkit YouTube video: Know the Score
  2. News Article
    NHS patients will wait longer for routine checks as part of a national drive to clear record backlogs. Health officials have instructed hospitals to “repurpose” resources to focus on those waiting the longest, who are yet to have their first appointment. Today the NHS claimed it had “virtually eliminated” two year waits, with less than 3,000 people enduring such delays, down from 22,500 at the end of January. Hospitals are being urged to prioritise those waiting 18 months or more, with pledges to get rid of such waits by April next year. NHS chiefs have instructed hospitals to focus on outpatient first appointments, rather than patients who have already had treatment, and are waiting for follow-up checks. Senior officials have said many such appointments are a “a waste of time” saying there should be more use of systems where routine slots are scrapped, and patients instead told to contact their medical team if they have particular concerns. The drive - which health chiefs dubbed “Super September” - will see priority given to tackling the longest waits. Read full story (paywalled) Source: The Telegraph, 9 August 2022
  3. Content Article
    With the number of outpatient hospital appointments in England recently as high as 125 million per year and a huge elective care backlog following the Covid-19 pandemic, patient-initiated follow-up on outpatient appointments has been touted as a potential solution in appropriate cases. But can it free up much-needed capacity while maintaining quality of patient experience and outcomes? As the NHS begins to expand its use of the approach, the NIHR RSET research team has conducted a first review of the available evidence.
  4. News Article
    A large acute trust is carrying out a major expansion of patient-initiated follow-up (PIFU) appointments, which is said to be “the most ambitious” project of its kind in the NHS. Norfolk and Norwich University Hospitals Foundation Trust has categorised around half of its outpatient follow-up list as “possible or probable opportunities” for patient-initiated pathways. NNUH wants to make PIFU the “default model” for patients who are not on active pathways, and where it is safe to do this. Its project is being closely watched by national leaders and has already drawn praise from NHS England’s director of elective recovery, Rob Stones, during a webinar last month. It is understood to be more ambitious than NHSE’s official PIFU pilot projects. NHSE’s elective chief, Sir Jim Mackey, has said he wants to expand PIFU pathways on an “industrial” scale. Read full story (paywalled) Source: HSJ, 29 July 2022
  5. Content Article
    Nearly half of all adults and approximately 8% of children (aged 5-17) worldwide have a chronic condition. Yet, studies have consistently shown that adherence to medication is poor; estimates range from under 80% to under 50%, with an average of 50%. There could be a considerable improvement in health outcomes (and consequently longevity), not only by developing new drugs, but by helping people adhere to existing treatment regimens that have already been researched, tested and prescribed for them. But adherence isn’t usually prioritised by governments, health providers or healthcare professionals (HCPs). Adherence isn’t measured at a national level for any disease, apart from in Sweden where hypertension is recorded. And as governments don’t prioritise adherence, health providers aren’t measured or incentivised for improving it, meaning HCPs may not have the time and resources (or reminders) to focus on it during consultations.  This report from the International Longevity Centre-UK (ILC) makes a series of recommendations.
  6. Content Article
    As Clare Gerada finished the final house calls of her long career in general practice, it struck her how detached she was from her patients now – and that it was not always like this. Where did we go wrong, and what can we do to fix it? she asks in this article in the Guardian.
  7. News Article
    Plans to scrap tens of millions of “unnecessary” hospital follow-up appointments could put patients at risk and add to the overload at GP surgeries, NHS leaders and doctors are warning. Health service leaders in England are finalising a radical plan under which hospital consultants will undertake far fewer outpatient appointments and instead perform more surgery to help cut the NHS backlog and long waits for care that many patients experience. The move is contained in the “elective recovery plan” which Sajid Javid, the health secretary, will unveil next week. It will contain what one NHS boss called “transformative ideas” to tackle the backlog. Thanks to Covid the waiting list has spiralled to a record 5.8 million people and Javid has warned that it could hit as many as 13 million. Under the plan patients who have spent time in hospital would be offered only one follow-up consultation in the year after their treatment rather than the two, three or four many get now. “While it is important that immediate action is taken to tackle the largest ever backlog of care these short-term proposals by the health secretary have the potential to present significant challenges for patients and seek to worsen health disparities across the country,” said Dr David Wrigley, the deputy chair of council at the British Medical Association. Read full story Source: The Guardian, 25 November 2021
  8. Content Article
    The Healthcare Safety Investigation Branch (HSIB) have identified a safety risk involving outpatient follow-up appointments which are intended but not booked after an inpatient stay. If a patient does not receive their intended follow-up appointment, it could lead to patient harm owing to delayed or absent clinical care and treatment. The investigation was launched after HSIB identified an event where a patient was discharged from hospital on two separate occasions with a plan to follow-up in outpatient clinics. Neither of the outpatient appointments were made.
  9. News Article
    An acute trust is reviewing thousands of gastroenterology cases for possible patient harm, after details emerged of an ‘extremely concerning’ list of patients who have not had follow-up appointments for up to six years since being treated. HSJ understands major concerns have been raised internally at Liverpool University Hospital Foundation Trust, over 9,500 patients who received treatment at Aintree University Hospital as far back as 2015, but have not had a follow-up appointment. Whistleblowers have also contacted the Care Quality Commission, which has confirmed it is looking into the issues. Well-placed sources said around 7,000 of the cases have “target dates” for an outpatient follow-up that are in the past. Around 20 of these cases were supposed to be seen in 2015 or 2016, with around 400 dating back to 2017, and around 900 to 2018, the sources said. The remaining 2,500 cases either have no target date or have not yet had a follow-up appointment booked. Read full story (paywalled) Source: HSJ, 8 April 2021
  10. Content Article
    Missed or failure to follow up on test results threatens patient safety. This qualitative study from Dahm et al. used volunteers to explore consumer perspectives related to test result management. Participants identified several challenges that patients experience with test-results management, including systems-level factors related to the emergency department and patient-level factors impacting understanding of test results.
  11. Content Article
    Dr Kathryn Leask outlines steps GPs can take to try and avoid patients coming to harm as a result of delayed referrals and provides advice on dealing with patient complaints on this issue. There are some steps GPs can take to try to avoid patients coming to harm while putting themselves in the best position to address the potential medico-legal ramifications. In their guidance on Delegation and referral the GMC says that you are not accountable for the actions or omissions of colleagues to whom you make referrals. However, you are accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. If you are aware that there are delays for a particular service and your patient is likely to be affected by this, you should make this clear to them and manage their expectations from the outset. In this GP Online article, Kathryn gives practical tips for GPs and shares a case example.
  12. Content Article
    The Re-Engineered Discharge (Project RED) programme is a nationally recognised best practice centered on delivering a patient-tailored hospital discharge plan demonstrated to reduce all-cause 30-day readmissions and improve safety during care transitions. In this study, Mitchell et al. implemented the RED in 10 hospitals to study the implementation process.
  13. Content Article
    This document from the Department of Health and Social Care (DHSC) sets out how health and care systems can ensure that people: are discharged safely from hospital to the most appropriate place. continue to receive the care and support they need after they leave hospital. It replaces ‘Coronavirus (COVID-19) hospital discharge service requirements’ published on 19 March 2020.
  14. News Article
    Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic. Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week. The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles. It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”. Read full story (paywalled) Source: HSJ, 7 August 2020
  15. News Article
    The aftercare of COVID-19 patients will have significant financial implications for ‘understaffed’ community services, NHS England has been warned. This month the national commissioner released guidance for the care of patients once they have recovered from an immediate covid infection and been discharged from hospital. It said community health services will need to provide “ongoing health support that rehabilitates [covid patients] both physically and mentally”. The document said this would result in increased demand for home oxygen services, pulmonary rehabilitation, diagnostics and for many therapies such as speech and language, occupational, physio, dieticians and mental health support. One GP heavily involved in community rehab told HSJ: “There is a lot detailed information about what people might experience in recovery, but it doesn’t say what should actually happen. “We have seen people discharged from hospital that don’t know anything about their follow-up and the community [health sector] hasn’t got any instructions of what they should be doing or what services have even reopened. This guidance needs to go a step further and rapidly say what is expected so local commissioners can put that in place.” Read full story Source: HSJ, 10 June 2020
  16. News Article
    Nearly 35,000 patients are overdue a follow-up appointment at North Lincolnshire and Goole Foundation Trust, HSJ has learned. Almost 20% of the 34,938 follow-up appointments are in ophthalmology. A paper from the trust’s November board meeting said the “backlog of follow-up appointments… clearly remains a risk”. The report also said the service was failing some of the quality guidelines set out by the National Institute for Health and Care Excellence (NICE). The trust told HSJ it had introduced a clinical harm review process last year to address the backlog. It has reviewed “more than 5,000 patients”, out of the 34,938 cases to date, according to Chief Operating Officer Shaun Stacey. He said the trust had initially identified 83 patients who could have come to “potential harm”. Read full story Source: HSJ, 28 January 2020
  17. News Article
    A national strategy is needed to tackle health risks linked to antipsychotic drugs because current policy is letting tens of thousands of people fall through the gaps, commissioners in London are warning. Commissioners and clinicians in City and Hackney found more than 1,000 patients in their area who were on these drugs without having regular medication reviews or health checks. They warned that, if their findings applied across England, 100,000 patients could be in the same position. Although NHS England funds GP practices to carry out regular health checks on patients who are on the serious mental illness register, this excludes patients who are prescribed antipsychotics without having an SMI diagnosis — which typically covers psychoses, schizophrenia or bipolar active disorder. An audit by City and Hackney Clinical Commissioning Group, carried out in July 2019 and shared with HSJ, found 1,200 patients in the area were taking antipsychotics but did not have a formal SMI diagnosis. The audit found most of these patients were not receiving regular health checks and a significant number may have benefited from having their medication reduced. Read full story (paywalled) Source: HSJ, 27 January 2020
  18. Content Article
    Lack of timely follow-up for glaucoma patients is a recognised national issue across the NHS. Research suggests that around 22 patients a month will suffer severe or permanent sight loss as a result of the delays. In this Healthcare Safety Investigation Branch (HSIB) report, the reference case patient saw seven different ophthalmologists and the time between her initial referral to hospital eye services (HES) and laser eye surgery was 11 months. By this time her sight had deteriorated so badly, she was registered as severely sight impaired. The HSIB  investigation identified that there is inadequate HES capacity to meet demand for glaucoma services, and that better, smarter ways of working should be implemented to maximise the current capacity. The report highlights that there are innovative measures implemented by some trusts that have reduced the risk, but this good practice is yet to be implemented more widely.
  19. Content Article
    The National Patient Safety Agency (NPSA) issued guidance on preventing delay to follow up for patients with glaucoma [NPSA/2009/RRR004]. This followed evidence of harm to patients with glaucoma suffering visual loss after delays to follow up appointments. This came to light from incidents reported by staff in the NHS relating to glaucoma. This paper provides background information and a checklist for organisations to help implement actions in the accompanying guidance to prevent harm from delayed follow-up appointments for patients with glaucoma. It presents details of incident data and litigation data. This work was supported by an interactive event in March 2009 with input from ophthalmic surgeons (and the Royal College of Ophthalmologists), nurses, service managers and patient representatives.
  20. Content Article
    In this research paper published in the Nature journal Eye, Foot and MacEwen determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period. They found that patients were suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This was occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.
  21. Content Article
    This blog has been written by a healthcare worker and demonstrates the reality of what it is like caring for patients and families while being chronically low on staff. They describe the impact this has on staff morale and the impact it has on patients, patients family members and the relationship between staff and patients.
  22. Content Article
    The Care Quality Commission (CGC) is the independent regulator of health and adult social care in England. They make sure that health and social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve.  Independent acute hospitals play an important role in delivering healthcare services in England, providing a range of services, including surgery, diagnostics and medical care. As the independent regulator, the CQC, hold all providers of healthcare to the same standards, regardless of how they are funded. 
  23. Content Article
    In 2015, the Agency for Healthcare Research and Quality (AHRQ) sponsored the development of a 'Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families'. One of the strategies introduced was a 'warm handoff' A warm handoff is a handoff conducted in person between two members of the health care team in front of the patient and family or caregiver. This video demonstrates warm handoffs in medical offices.
  24. Content Article
    Alison Phillips tells HSJ her story and why she's campaigning for the deteriorating patient and safety.
  25. Content Article
    Imperial College Healthcare NHS Trust devised this inforgraphic to assist with navigating the the complaints system within the Patient advice and liaison service (PALS).
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