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Found 107 results
  1. News Article
    Stroke patients in England are waiting an average of almost seven hours for a specialist bed, double the wait reported before Covid. National performance against key measures collected by the Sentinel Stroke National Audit Programme has nosedived, with patients in England waiting an average of almost seven hours to be admitted to a specialist unit in 2022-23, compared to three and a half hours in 2019-20. NHS England guidance states that every patient with acute stroke should be given rapid access to a stroke unit within four hours. This time frame is considered critical, as patients can only be given clot-busting drugs, and treatments such as thrombectomy, which surgically removes a clot, within the first few hours of stroke onset. However, this was achieved in just 40% of cases last year (2022-23), down from 61% in 2018-19. Juliet Bouverie, CEO of the Stroke Association, urged ministers to give trusts what they needed to reverse the decline, saying: “Stroke is a medical emergency and every minute is critical. “We are very concerned to see that, far from improving over the last year, the proportion of stroke patients being admitted to a stroke ward within the timescale for thrombolysis has continued to decline. This is putting patient recoveries at risk and strain on the rest of the health system. “We believe that early supported discharge, when done correctly, with adequately resourced community teams, can help to alleviate capacity pressures in acute stroke units. However, this is not a silver bullet. There are longstanding workforce issues which are affecting patient flow in, through and out of stroke units and we call on DHSC to properly address these in the workforce plan.” Read full story (paywalled) Source: HSJ, 2 January 2024
  2. Content Article
    Rob Behrens reflects on the work the Parliamentary and Health Service Ombudsman (PHSO) has done over the last year to drive improvements in patient safety.
  3. News Article
    Ambulance handover delays rose last week with close to 13,000 crews waiting more than an hour to offload patients — marginally more than the comparable week last year. Week of 27 November 2023 figures were missing data for several days from some trusts, NHSE said. The number of hour-plus waits for ambulancs to pass patients to emergency departments was 12,797, according to new NHS England data. That appeared to be steeply up from about 8,000 in the past two weeks, although NHSE said last week’s was not directly comparable due to missing data. It was just ahead of the 12,534 recorded for the week ending 11 December last year. Last year the numbers rose to over 16,000 in the third week in December then peaked at 18,720 in the week running up to New Year, in what many said was the worst winter crisis for decades, amid a sharp, early wave of flu. This year the numbers of long waits have risen earlier than last, and several ambulance trusts have reported coming under severe pressure in the last few days. NHS England has warned junior doctors strikes next week and in the new year may compound hospital flow problems. Read full story (paywalled) Source: HSJ, 15 December 2023
  4. News Article
    Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays. In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”. The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls. The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working. “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.” Read full story (paywalled) Source: HSJ, 11 December 2023
  5. News Article
    Ministers must intervene over systemic failures which are “too big for hospital or ambulance trusts to fix on their own” and have led to multiple preventable deaths, a senior coroner has warned. In a move usually considered rare for such an official, Cornwall and Isles of Scilly coroner Andrew Cox has written to the Department of Health and Social Care a second time over ongoing delays to ambulance responses and long ambulance handovers in the area. Last year he warned the NHS was “broken” after he ruled ambulance and emergency care delays contributed to the deaths of four people. Now, he has sent a similar report on the same types of failings in the deaths of John Seagrove, Pauline Humphris, and Patricia Steggles at Royal Cornwall Hospital to new health secretary Victoria Atkins. Mr Cox wrote: “I set out in my [prevention of future death report] last year my understanding of the reasons for the difficulties that are continuing in the Cornwall & Isles of Scilly coroner area. I do not believe those reasons will have changed significantly. ”The challenges are systemic in nature. They are too big for a single doctor, nurse or paramedic to fix. They are too big for either the hospital trust or the ambulance trust to fix on their own.” Read full story Source: HSJ, 1 December 2023
  6. News Article
    Patient safety is being put at risk by the “toxic” behaviour of doctors in the NHS, the health ombudsman has said. Rob Behrens, who investigates complaints about the NHS in England, warned that the hierarchical and high-handed attitude of clinicians was undermining the quality of care in some hospitals. He called for medical training to be redesigned to encourage a more empathetic and collaborative approach from doctors. Pointing to failings in the treatment of sepsis and the problems in maternity services, Behrens said he was “shocked on a daily basis” by what he saw as ombudsman. Too often, “organisational reputation has been put above patient safety”, he told The Times Health Commission. The ombudsman warned of a “Balkanisation” of health professionals, with rivalries between doctors and nurses or midwives and obstetricians harming patient care. “For all the brilliance of clinicians quite often they’re not very good at working together,” he said. “Time and again, the handover from one clinician to another, from one shift to another, or the inability to raise the issue at a senior level has been a key factor in what has gone wrong.” Read full story (paywalled) Source: The Times, 18 November 2023
  7. News Article
    Hospitals are being prevented from adopting models which spread risk away from emergency departments because other teams refuse to take on the extra work, according to a top accident and emergency doctor. In a recent interview with HSJ, North Bristol Trust chief executive officer Maria Kane praised her trust’s risk-sharing approach to emergency care, which involves moving patients each hour from accident and emergency to the most appropriate ward for their needs and where a discharge is expected, even if it is full. Commenting on the article, Royal College of Emergency Medicine president Adrian Boyle said: “The NBT trust leadership deserve significant credit for maintaining this. All too often there is an acceptance of unacceptable delays (and risk) in ambulance handovers and long ED stays. “Where this fails, it is usually because inpatient teams (both nursing and medical) have objected to the extra workload, without appreciating the real harm elsewhere. The more interesting question is why isn’t this being done more widely?” Read full story (paywalled) Source: HSJ, 15 November 2023
  8. News Article
    Ambulance chiefs say handover delays have got worse at some trusts in recent months, despite the picture improving nationally since last winter. A report from the Association of Ambulance Chief Executives says there are continuing concerns about handover delays at emergency departments. Jason Killens, the body’s lead chief executive for operations, told HSJ: “There’s been some improvement [at some sites] since February, but what we’ve also seen is a commensurate or bigger decay in other sites across that same period.” Mr Killens said “it’s difficult to be precise” about why some trusts have struggled more than others but that challenged hospitals are often affected by “pathway issues” including delayed discharges. “And then maybe there are challenges around stable leadership or the visibility of the leadership, the culture there about managing that risk dynamically, and so on,” he added. Read full story (paywalled) Source: HSJ, 14 September 2023
  9. Content Article
    The Association of Ambulance Chief Executives (AACE) has published a new report charting the major increase in the frequency and length of hospital handover delays over the past ten years, calling for an even greater focus on improvements that will reduce and eradicate delays, prevent more patients from coming to significant harm and stop the drain on vital ambulance resources.
  10. Content Article
    On the 20 February 2019 an investigation commenced into the death of Bethan Naomi Harris who was born on the 16 November 2018 at the St George's University Hospitals NHS Foundation Trust. Bethan Naomi Harris died at Shooting Star Hospice on the 26 November 2018. Her mother's pregnancy had been uneventful. After admission to labour ward labour progressed very quickly indeed and Bethan sustained severe brain injury during delivery. Despite best efforts by the neonatal team she succumbed to her injuries. The Investigation concluded at the end of the Inquest on the 19 November 2019. The conclusion of the inquest was that the medical cause of Bethan's death was (1a) hypoxic ischaemic encephalopathy.
  11. Content Article
    A casually centred proposal identifying how Fire and Rescue Services can improve pre-hospital care and quality of life outcomes for burn survivors.  David Wales and Kristina Stiles have released this report looking at the burn survivor experience in the pre-hospital environment. The work makes ten operational recommendations and also two 'lessons learned' recommendations exploring strategic partnership working and the resulting fragmented services.
  12. Content Article
    Hospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.
  13. Content Article
    This white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
  14. Event
    This Hospital at Night Summit focuses on out of hours care in hospitals delivering high quality safe care at night, and supporting the wellbeing of those working at night. Through national updates, networking opportunities and case studies this conference provides a practical guide to delivering a high quality hospital at night and transforming out of hours services and roles to improve patient safety. The 2023 conference will focus on the developing an effective Hospital at Night service, and focus on the practicalities of supporting staff at night, improving wellbeing and fighting fatigue. Benefits of attending this conference will enable you to: Network with colleagues who are working to improve Hospital at Night Practice. Learn from recent developments. Improve your skills in the recognition management and escalation of deteriorating patients at night. Understand and evaluate different models for Hospital at Night. Examine the role of task management solutions for Hospital at Night, including handover and eObservations. Ensure effective and safe staffing at night. Improving and supporting the wellbeing of hospital at night staff. Examine Hospital at Night team roles, competence and improve team working. Improve safety through the reduction of falls at night. Supporting staff and reducing fatigue at night. Develop the role of Clinical Practitioner and Advanced Nursing Practice at night. Identify key strategies to change practice and ways of working in Hospital at Night. Understand how hospitals can improve conditions for night workers and support Junior Doctors. Self assess and reflect on your own practice. Supports CPD professional development and acts as revalidation evidence. This course provides 5 Hrs training for CPD subject to peer group approval for revalidation purposes. Register hub members receive a 20% discount. Email info@pslhub.org for discount code.
  15. Content Article
    Traditional approaches to patient safety and handoffs need redesigning to acknowledge the different constraints, goals, and requirements necessary for each individual patient. There is no “one size fits all” approach to patient safety, handoffs or a perfect checklist. Despite the inherit complexity present in healthcare systems, we tend to reduce our thinking about handoffs into simple solutions of checklists and cognitive aids. In studies of these tools, their association with patient outcomes is unclear with mixed results in large studies. Incorporating general resilience engineering principles of visibility, understanding, anticipation, and learning provides new opportunities for increased patient safety. This involves situating the handoff in the context of the system - understanding the process of summarising pre-handoff and of developing understanding post-handoff, tracing flows of information and patients, and considering the role of feedback and control loops in the system. Direct observations, analysis of multiple outcomes, focus on patient evolving specific exceptions, reducing the number of handoffs, taking time for two-way discussions, and user-centred design and redesign may promote acceptability and sustainability of a new view of handoffs for improved patient safety.
  16. News Article
    Record numbers of patients suffered severe harm last month because they spent so long in the back of ambulances waiting to get into A&E, new NHS figures reveal. An estimated 57,000 people in England “experienced potential harm”, of whom 6,000 were exposed to “severe harm”, in December – both the largest numbers on record – because they had to wait at least an hour to be handed over to hospital staff, according to NHS ambulance service bosses. The health union Unison, which represents many ambulance staff, said the data showed that the ambulance service “is barely coping” with the huge number of calls it is receiving. A senior ambulance service official said the high volume of patients being put at risk because they had to wait outside A&E so long before receiving medical attention, and paramedics being prevented from answering other 999 calls, was “horrific” and “astronomical”. He added: “These figures also show that whatever NHS England say they are doing to try to resolve this huge problem, it clearly isn’t working.” Martin Flaherty, Association of Ambulance Chief Executives (AACE) managing director, said: “Our December 2022 data for handover delays at hospital emergency departments shows some of the worst figures we have recorded to date and clearly underlines that not enough is being done to reduce and eradicate these dangerous, unsafe and harmful occurrences.” Read full story Source: The Guardian, 25 January 2023
  17. Content Article
    Inadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project, published in Patient Safety, aims to improve hand-off communication from hospital to SNF by utilising a standardised hand-off tool. Authors conclude that the use of standardised hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardised hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.
  18. News Article
    Hours lost to ambulance handover delays, and the numbers of ambulances waiting more than an hour outside hospitals hit new highs in the week after Christmas. Data published this morning by NHS England revealed nearly 55,000 hours were lost to delays between 26 December and 1 January and 18,720 ambulances had to wait more than an hour to handover patients as emergency departments struggled, with many trusts declaring critical incidents. The number of hour-plus delays followed previous years’ trend of a slight dip in the week leading up to Christmas followed by an acceleration afterwards. However, levels this year were more than twice those seen in 2021 and three times those of the previous two years. Read full story (paywalled) Source: HSJ, 6 January 2023
  19. News Article
    Paramedics will only wait with patients for 45 minutes before leaving them on a trolley in A&E, one ambulance trust has said. One in five ambulances are waiting at least an hour outside accident and emergency departments to hand over patients, the latest data show, despite NHS standards stating it should only be 15 minutes. Now, London Ambulance Service (LAS) leaders have told hospitals their staff will only remain with patients for a maximum of 45 minutes for handover due to “the significant amount of time being lost” waiting in A&E departments. A leaked letter, seen by ITV News, from the LAS said: "From January 3 we are asking that any patients waiting for 45 minutes for handover... are handed over immediately to ED (emergency department) staff allowing the ambulance clinicians to leave and respond to the next patient waiting in the community. "If the patient is clinically stable the ambulance clinicians will ensure the patient is on a hospital trolley or wheelchair/chair and approach the nurse in charge of the emergency department to notify them that the patient is being left in the care of the hospital and handover the patient." The email added that if the patient was not clinically stable, ambulance crews would stay with the patient until handover is achieved but added that the clinical responsibility for the patient lied with the hospital. Read full story (paywalled) Source: The Telegraph, 3 January 2023
  20. News Article
    NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows. NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas. HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document. The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”. Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral. Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. Read full story (paywalled) Source: HSJ, 4 January 2022
  21. Content Article
    NHS England has published its planning guidance for 2023/2023. The 2023/24 priorities and operational planning guidance reconfirms the ongoing need to recover our core services and improve productivity, making progress in delivering the key NHS Long Term Plan ambitions and continuing to transform the NHS for the future.
  22. News Article
    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
  23. News Article
    All ambulance services have declared the highest level of alert due to ‘extreme pressures’ facing the urgent and emergency care system. One senior ambulance chief told HSJ that ambulance response times have dropped dramatically in the last few days, while A&E handover delays have surged. They said: “The wheels are falling off [the emergency care system] now, we’re in a really awful situation.” They said ambulance leaders have major concerns about the planned strike action by nurses on Thursday, fearing this will exacerbate discharge delays and have a knock-on effect on ambulance handover problems. It also comes ahead of strike action planned by ambulance staff for next week. HSJ has seen internal communications which confirm all ten ambulance trusts in England are now in level four of their “resource escalation action plan”, which means they can seek assistance from other nearby trusts or services. However, this is more difficult when an entire sector is under pressure, as is the case currently. Read full story (paywalled) Source: HSJ, 13 December 2022
  24. Content Article
    The University Hospital Southampton share their poster on using NEWS2 and SBAR.
  25. 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
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