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Found 109 results
  1. Content Article
    The University Hospital Southampton share their poster on using NEWS2 and SBAR.
  2. News Article
    When 85-year-old Koulla fell at home, her family immediately rang for an ambulance. She was in agonising pain - she had broken her hip. It was around 8pm. It took another 14 hours for an ambulance to get to her, leaving her pregnant granddaughter to care for her through the night. When they arrived the crews were able to give her pain relief and quickly transported her to the Royal Cornwall Hospital. But there the wait continued - there were around 30 ambulances queuing to handover patients to A&E staff. It was another 26 hours before she was taken inside to A&E. She then faced many hours in A&E before being taken for surgery. Koulla's daughter, Marianna Flint, 53, said: "It was awful. You feel helpless because you're giving your trust over to them to look after a family member who's in agony and who needs surgery." She has since received a written apology from the Royal Cornwall for the care provided to her mother in August. Ms Flint said: "I almost feel sorry for those looking after her. It's not down to them. There was no room inside to accept her in." Read full story Source: BBC News, 1 December 2022
  3. News Article
    The NHS in England is facing a “perfect winter storm” with 10 times more people in hospital with flu than this time last year, and ambulances experiencing deadly delays when arriving at A&E with sick patients. There were an average of 344 patients a day in hospitals in England with flu last week, more than 10 times the number at the beginning of last December. And as many as 3 in 10 patients arriving at hospitals by ambulance are waiting at least 30 minutes to be handed over to A&E teams. Health chiefs say the crisis is leading to deaths. The figures on flu and ambulance delays were published by NHS England on Thursday and offered the first weekly snapshot of how hospitals are performing this season. Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, said: “These figures really hammer home just how stretched services already are as we head into a perfect winter storm. Significantly higher numbers of people are in hospital because of flu compared to this time last year, coupled with the fact that Covid-19 has not gone away.” He added: “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays, and patients are dying and coming to harm as a result on a daily basis.” Read full story Source: The Guardian, 24 November 2022
  4. News Article
    Nine acute trusts accounted for a third of all ‘hours lost’ to ambulance handover delays last week, according to new data. The first NHS England winter sitrep data showed wide variation between providers on ambulance handover performance, with a small number of providers accounting for a huge proportion of delays. There were nine trusts where, for each ambulance arrival in the week to 20 November, an average (mean) of more than an hour was lost to handover delays. The providers accounted for around 7,000 hours lost, 33% the national total, despite only accounting for 7% of ambulance arrivals. At University Hospitals Plymouth an average of 2.3 hours were lost. The other trusts were; Norfolk and Norwich University Hospitals; East and North Hertfordshire; The Queen Elizabeth Hospital King’s Lynn; Great Western Hospitals; University Hospitals of Leicester; Torbay and South Devon; University Hospitals of North Midlands; and Worcestershire Acute Hospitals. Many of the worst performing hospitals were in the South West and East of England regions, which have previously been identified as areas which struggle on handover delays. Read full story Source: HSJ, 24 November 2022
  5. News Article
    Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands. Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays. For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis. HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account. Read full story (paywalled) Source: HSJ, 23 November 2022
  6. News Article
    Ambulance crews could not respond to almost one in four 999 calls last month – the most ever – because so many were tied up outside A&Es waiting to hand patients over, dramatic new NHS figures show. An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” through waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them. Ambulance officers warned that patients were dying every day directly because of the delays since the service could no longer perform its role as a “safety net” for people needing urgent medical help. “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis,” said Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 regional NHS ambulance services. Flaherty added: “Our national data for hospital handover delays during October 2022 is extremely worrying and underlines the fact that in some parts of the country efforts to reduce or eradicate these devastating and unnecessary delays are simply not working.” Read full story Source: The Guardian, 23 November 2022
  7. News Article
    Ambulance waiting times for stroke and suspected heart attacks have quadrupled in four parts of England since before Covid-19 – whereas others have only grown by half – underlining the severe impact of long accident and emergency handovers. Response times have leapt across England over the past two years, particularly for category 2 and 3 incidents, but the data makes clear that the steepest increases are in areas where hospitals have the biggest handover delay problems. Of the 10 patches with the largest increases in average category 2 performance between 2018-19 and 2021-22, four are served by major hospitals which make up NHS England’s “cohort one” of trusts selected for the worst handover problems; and four more are on government’s list of 15 which accounted for the most long handover delays last winter. The increase in handover delays – in turn linked to delayed discharge, staffing, lack of community services and social care’s collapse – are the stand-out reason for areas with a steep rise in response times. Read full story (paywalled) Source: HSJ, 18 November 2022
  8. News Article
    An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022
  9. Content Article
    Ambulance services in England are under immense pressure. In July 2022, all ambulance services in England declared REAP (Resource Escalation Action Plan) level four, reflecting potential service failure. Volumes of calls to 999 are increasing, patients in distress and pain are waiting longer for help to reach them, and ambulance teams feel unable to do their job well. The new Secretary of State for Health and Social Care has previously named cutting ambulance waits as his number one priority. As he takes up the role for the second time, he will again need to include ambulances in his list of priorities for the health and care system. Steps taken to date to help address the underlying issues have not yet had an impact on the pressures facing ambulance services. This analysis from The Health Foundation looks at ambulance service performance and explores the contributing factors and priorities for improvement.
  10. Content Article
    This investigation by the Healthcare Safety Investigation Branch (HSIB) explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. This is the second interim bulletin published as part of this investigation, and findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. The reference event in this investigation involves a patient who was found unconscious at home and taken to hospital by ambulance. They were then held in the ambulance at the emergency department for 3 hours and 20 minutes and during this time their condition did not improve. The patient was taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
  11. News Article
    A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis. Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers. Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk. He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk. “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there. “I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations. “Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.” Read full story (paywalled) Source: HSJ, 28 October 2022
  12. Content Article
    The Healthcare Safety Investigation Branch's (HSIB's) local investigation pilot aimed to evaluate the organisation's ability to carry out effective locality-based patient safety investigations with actions aimed at specific NHS organisations, while still identifying and sharing relevant national learning. It differs from HSIB's usual national investigations, which make safety recommendations to organisations that can make changes at a national level across the NHS in England. The pilot published three investigations focused on cross boundary and multi-agency safety events: Investigation 1: incorrect patient identification Investigation 2: incorrect patient details on handover Investigation 3: transfer of a patient with a stroke to emergency care The report summarises how the HSIB local investigation pilot was undertaken, and shares findings applicable to local healthcare systems including healthcare organisations and Integrated Care Systems.
  13. Content Article
    This Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
  14. News Article
    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
  15. News Article
    NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned. The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards. The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays. On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays. In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”. Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients. However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E. Read full story Source: The Independent, 4 September 2022
  16. Content Article
    In order to become competent clinicians, doctors need to appropriately calibrate their clinical reasoning, but lack of follow-up after transitions of care can present a barrier to this. This study in the Journal of Hospital Medicine aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. The authors concluded that structured feedback for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.
  17. News Article
    Doctors and health service providers welcomed publication of an NHS strategy for managing demand ahead of another busy winter for health and social care, but said it failed to address underlying problems with the system. In a letter to the heads of NHS trusts and integrated care boards, NHS England chiefs said they had begun planning for capacity and operational resilience in urgent and emergency care ahead of "significant challenges" during the coming months. The British Medical Association (BMA) said the strategy was a "step in the right direction", but "lacks detail", while the Royal College of Emergency Medicine (RCEM) said it amounted to little more than "a crisis mitigation plan". The package of measures included creating the equivalent of 7000 extra general and acute beds through a mix of new physical beds, scaling up 'virtual' beds, and "improvements in discharge and flow". The letter acknowledged that there was "a significant number of patients spending longer in hospital than they need to" and that whilst "the provision of social care falls outside of the NHS’s remit, the health service must ensure patients not requiring onwards care are discharged as soon as they are ready and can access services they may need following a hospital stay." Read full story Source: Medscape, 15 August 2022
  18. Content Article
    Research undertaken by digital health platform, CAREFUL shows that handover in hospitals is the cause of frequent and severe harm to patients.
  19. News Article
    The NHS has broken its “fundamental promise” to the public that life-saving emergency care will be available when they need it, a top NHS doctor has said, as ambulances continue to lose tens of thousands of hours waiting outside hospitals. Katherine Henderson, the president of the Royal College of Emergency Medicine, said that what she described as the fundamental promise of the NHS to provide an ambulance in a real emergency has been “broken”. Her comments come as the West Midlands Ambulance Service (WMAS) University NHS Trust predicted it would lose 48,000 ambulance hours waiting outside A&E departments in July. This would make it the worst month on record. In papers published on Thursday, WMAS said the impact of handover delays means that patients are waiting longer than needed for an emergency response, including patients in category one, which includes those needing immediate life-saving care. It added: “This means that patients who are immediately time-critical medical emergencies do not get the response they need and may suffer significant harm or death.” Read full story Source: The Independent, 26 July 2022
  20. News Article
    Serious incidents causing patient harm have increased steeply compared to previous years at an ambulance service whose nursing director still expects will “fail” next month under mounting service pressures. There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year. The figures show that from April-June this year, 262 harm incidents have been logged – a 240% on 77 in the same period in 2019 and a 71% on 153 last year. Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”. Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed. “Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long." Read full story (paywalled) Source: HSJ, 15 July 2022
  21. News Article
    NHS England’s director of community health has said a new strategy for rehabilitation care is needed, because present coverage is sometimes ‘bizarre’, with other services ‘masquerading’ as rehab. Matthew Winn, who is also Cambridgeshire Community Services Trust CEO and senior responsible officer of the “ageing well” programme in the NHS long-term plan, made the comments in a webinar for local senior clinicians and managers in the sector. He said there was an intention to roll out a national “intermediate care strategy”, describing it as “the essence” of providing rehabilitation and helping hospital patients to “optimise, to recover, to rehab through a skilled multiprofessional team”. They would leave hospital in a “timely pathway” and not need as much social care support afterwards. It comes amid huge pressure to speed up hospital discharge, which often relies on rehab services. Read full story (paywalled) Source: HSJ, 14 July 2022
  22. Content Article
    Report from the Association of Ambulance Chief Executives on national ambulance data.
  23. News Article
    A spike in Covid absences and the extended heatwave have left NHS hospitals and ambulance services struggling to cope. The hot weather is also driving more patients to A&E departments, and callers are being urged not to use 999 except in serious emergencies. All 10 ambulance trusts in England are on black alert, the highest level, while health leaders warn that “ill-equipped” hospital buildings are struggling to store medicines correctly amid the abnormally high temperatures. Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said: “The NHS ambulance sector is under intense pressure, with all ambulance services operating at the highest level of four within their local resource escalation action plans, normally only ever reserved for major incidents or short-term periods of unusual demand. “Severe delays in ambulance crews being able to hand over their patients at many hospital emergency departments are having a very significant impact on the ambulance sector’s ability to respond to patients as quickly as we would like to, because our crews and vehicles are stuck outside those hospitals.” Read full story Source: The Independent, 12 July 2022
  24. News Article
    An ambulance trust lost 1,700 hours of working time in one week in April due to vehicles waiting outside a hospital. The BBC has discovered that the figure was reached twice during April as ambulance crews waited outside Gloucestershire Royal Hospital in Gloucester to handover patients. That equates to about 70 days worth of waiting time each week. The trust that runs the hospital said it was facing "significant challenges" as it dealt with "unrelenting demand". Figures show that since the end of January, South Western Ambulance Service NHS Foundation Trust (SWASFT) has lost a minimum of 800 hours of working time each week due to ambulances having to wait outside Gloucestershire Royal Hospital, unable to get patients into A&E. The national target for transferring patients from ambulances in to A&E is 15 minutes, but in some cases people had to wait up to 10 hours in ambulance queues in Gloucester. Read full story Source: BBC News, 12 July 2022
  25. News Article
    Hospital leaders say they have been pressured to deliver more ‘corridor care’ as a result of efforts to ease the ambulance handover crisis. Due to the collapse in ambulance response times over the last year, hospitals have been told to receive patients from ambulance crews more quickly, to enable those crews to respond to new incidents in the community. This can mean patients being kept on trolley beds in corridors, with a lack of appropriate staff to care for them. Tracy Bullock, chief executive of University Hospitals of North Midlands, told HSJ her trust almost eradicated “corridor care” before the pandemic. But she added: “There have been discussions about going back to corridor care, but we have resisted that, as it brought significant patient safety and staff wellbeing issues… although these never received the same airtime as ambulance waits as they are unseen and only impact on the acutes. “The terminology has now changed and instead of corridor care it’s ‘cohorting’, and the space is not necessarily a corridor but a designated space for ambulances to drop more patients off.” She said this only works with enough staff, “otherwise you end up with the same safety issues that we had delivering corridor care pre-pandemic”. Read full story (paywalled) Source: HSJ, 11 July 2022
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