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Found 17 results
  1. News Article
    NHS England was aware of concerns about upper gastrointestinal surgery at a hospital nearly three years before the Care Quality Commission intervened to stop it being carried out, HSJ can reveal. NHSE in the South East commissioned a report into upper GI cancer services in parts of the region in January 2020. In particular, HSJ understands the review was prompted by concerns the small number of surgeries carried out at the Royal Sussex County Hospital in Brighton meant it may be unable to comply with parts of the service specification and face difficulties maintaining an adequate surgical workforce rota. Despite these concerns, Brighton continued to carry out upper GI surgery until the CQC suspended planned oesophagic-gastric resections last August. Read full story (paywalled) Source: HSJ, 14 March 2023
  2. Content Article
    Key findingsPatients experienced long delays from time of arrival at hospital to time of surgery, including those with sepsis suspected at arrival in hospital (median 15.6 hours to theatre)Many patients (77.7%) with suspected sepsis on arrival did not receive antibiotics within an hour of arrival in hospitalOne in five high-risk patients did not receive postoperative care in a critical care unit.Frailty doubled the risk of mortality of patients aged 65 and over (13.0% vs 5.9%), but review by a member of the elderly care team was associated with a significant reduction in mortality (5.9% vs 9.5% amongst non-frail patients, and 13.0% vs 22.3% amongst frail patients). However, this is not routine practice in many hospitals.
  3. Content Article
    The report contains a number of findings related to: patterns of care at diagnosis staging and treatment planning waiting times along the care pathway curative surgery non-curative treatments. It also includes findings relating to the impact of the Covid-19 pandemic, including: In April 2020, the number of patients diagnosed with OG cancer was 43.6% of the 2019/20 monthly average, falling from 837 to 365 cases per month. The numbers diagnosed soon returned to normal levels, and in the period from June 2020 to March 2021, the number of monthly cases was 97.8% of 2019/20 levels. The percentage of patients diagnosed with stage 4 disease (advanced cancer) increased from 41.6% in 2019/20 to 44.9% in 2020/21. The report also contains recommendations for healthcare professionals, among which is including a call to review patients diagnosed after emergency admission and undertake root cause analysis to identify opportunities to reduce rates of emergency diagnosis.
  4. News Article
    A consultant surgeon refused to attend hospital to carry out urgent surgery at a trust which later had upper gastrointestinal surgery suspended after an unannounced Care Quality Commission visit. The CQC report into upper GI surgery at the Royal Sussex County Hospital in Brighton – based on an inspection in August – said incident reports revealed occasions when upper GI surgeons could not be contacted or refused to come into hospital to treat patients. In one case, a consultant would not come in to carry out urgent surgery, it added. Low numbers of surgeons meant the on-call rota for upper GI was shared with the lower GI surgeons. This meant an upper GI specialist was not always available immediately, despite guidance from a professional body that 24/7 subspecialty cover was needed at centres which carry out major resectional surgery. This surgery was suspended at the RSCH after the August inspection and has yet to be reinstated. Mortality at both 30 and 90 days for patients with oesophago-gastric cancer was twice the national average between 2017 and 2020 – though the trust was not an outlier – and there was an increasing number of emergency readmissions for patients who had undergone upper GI surgery, the report said. Read full story (paywalled) Source: HSJ, 1 December 2022
  5. Content Article
    Dena’s vigilance and persistence as a whistleblower led to an investigation by The Centres for Medicare and Medicaid Services (CMS). Based on interviews and a review of hospital records, CMS found specific events contributing to her mother’s death and issued findings in a Summary Statement of Deficiencies. Among the key problems, Martha had not been thoroughly assessed when changes in her condition occurred. In one instance, at 10:15pm, (14 hours after the procedure), the Registered Nurse failed to perform a thorough assessment, that included vital signs and notifying the doctor. The CMS report also showed how after Martha’s death the hospital tried to cover up what happened.
  6. Content Article
    Coroner's concerns The NHS 111 telephone triage service uses the NHS Pathways computer system to triage patients via pre-determined question/answer based algorithms. The pre-determined questions are the same whether the caller is an adult or a child. Alex struggled to comprehend some of the medical terminology used during these calls. Call handlers are not permitted to deviate from the prescribed wording of the pre-determined questions, and this created confusion and inconsistency in the patient’s answers. Consideration should be given as to how young and/or vulnerable patients can be assisted to provide accurate information about their symptoms. The NHS Pathways algorithm for triaging vomiting and diarrhoea symptoms is unclear as patients may fail to understand what is meant by ‘soil’ or ‘coffee ground’ vomit. Consideration should be given to how this important diagnostic feature can be explored during telephone triage, especially when the patient is young and/or vulnerable. The NHS 111 telephone triage service provides an electronic copy of the patient triage notes to the patient’s GP within minutes of the call ending. There was a delay of 7 days in the GP surgery uploading the 111 triage document to Alex’s patient record. This prevented Alex’s GP from reviewing the triage note prior to his consultation with the patient. There is no guidance as to expected practise with regards to the timely updating of electronic patient records, and as a result delays are all too frequent. Adults presenting to their GP or Emergency Department with abdominal symptoms receive a lipase and/or amylase blood test as part of the standard package of blood testing. The levels of each of these enzymes can be used to diagnose pancreatitis. Patients under the age of 18 years are not offered this testing as standard, on the basis that pancreatitis is rare in paediatric patients. The coroner heard anecdotal evidence of some doctors at Kingsmill Hospital now add this test to the standard admission bloods for older teenage patients who present with non-specific abdominal symptoms but the NICE guidance (September 2018) is not explicit in this regard. Consideration ought to be given to a national approach for lipase/amylase testing in young people with relevant symptoms. Patients who make an unscheduled return to the Emergency Department within 72 hours of discharge are required to have a review undertaken by an ED Consultant, or a ST4 trainee or above in the absence of a Consultant on the ‘shop floor’: RCEM Guidance June 2016. Some hospitals will admit returning paediatric patients for observations but practise seems to vary doctor-to-doctor and across Trusts. Consideration ought to be given to a national approach.
  7. Content Article
    Gastrointestinal complaints are very common and account for one in ten GP consultations in England. This GIRFT report reviewed 129 gastroenterology teams in England and contains 24 recommendations to improve patient care, including: extending service hours (by recruiting additional staff). introducing specialist triage of referrals at an earlier stage. introducing more proactive care programmes for patients with chronic conditions. You will need a FutureNHS account to view this report, or you can view a short video summary which includes key recommendations.
  8. News Article
    A trust’s gastroenterology service was ‘in a very poor state with significant risks to patient safety’ and had poor teamworking which “blighted” the service, an external review found. The problems in the service at Salisbury Foundation Trust, Wiltshire, were so severe that the Royal College of Physicians suggested it should consider transferring key services such as management of GI bleeds and the care of hepatology patients to other hospitals. The service was struggling with poor staffing which had led to increased reliance on a partnership with University Hospital Southampton Foundation Trust, outsourcing and the daily use of locum consultants, according to the report. The trust board had identified “inability to provide a full gastroenterology service due to lack of medical staff capacity” as an extreme risk. The report said: “This review was complex and necessary as the gastroenterology service is in a very poor state with significant risks to patient safety and the reputation of the trust. We found a wide range of problems which now need timely action to ensure patients are safe.” Read full story (paywalled) Source: HSJ, 7 June 2021
  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
    Key points include: Misplacement and use of nasogastric feeding tubes leads to ongoing avoidable complications and deaths classified as Never Events despite multiple NHS Alerts since 2005. The most common cause relates to use of X-rays to confirm intragastric placement, followed by poor adherence to guidance on use of gastric aspirate pH, although the vast majority of nasogastric feeding tubes in the UK are passed safely and have their position confirmed using pH checks without issue. The root cause of these problems is a failure by Hospital Trusts and Health Boards to implement guidelines through rigorous clinical governance over many years. The perception of nasogastric feeding tube insertion as a “simple” procedure must be changed to that of a “complex” and dangerous procedure and limited to properly trained and competent healthcare professionals. The ongoing incidence of nasogastric Never Events is symptomatic of a wider failure of NHS governance procedures centrally and at senior Trust level. It must be accepted that this method of feeding is associated with a risk of complications and death which requires new strategies to mitigate these risks and to place patient safety at the top of the agenda.
  11. Content Article
    The author of both reports, Margaret Jones HM Assistant Coroner, notes the matters of concern are as follows: The product description used by Enteral was insufficient to enable the end user to clearly identify that the tube marketed as a carefeed size 14FR feeding and drainage tube would not operate as a 14Fr tube due to the restricting en-fit connector. Enteral sales marketing staff were not trained to recognise the new restriction in the bore of the tube and were consequently unable to advise the end user of the change. The Hospital Trust did not fully evaluate the size 14FR tube prior to replacing all previous drainage tubes (Ryles) with the carefeed 14Fr feeding and drainage tube. Feedback was generally difficult to obtain. Nursing staff did not consider alternative action when the NG tubes were not adequately draining. There was no general recognition of the need to aspirate the tube. There is no compulsory training of clinicians required to undertake root cause analysis. Despite reports to the MHRA and issue of amended instructions for use and a field safety notice the product continues to be promoted as suitable to feeding and drainage. Please see link to the Nursing times. This was a joint inquest into the death of two patients who died in quick succession as a result of the Enteral 14F nasosgastric tube being used for decompression in an emergency situation. Four similar (non-fatal) incidents followed. It was not clear to the hospital that the Enteral connector reduced the bore of the size 14Fr tube. The inquest was aware that other Hospital Trusts had also needed to change the tubes. I am concerned that the product labelling problem identified during these inquests may not be limited to the University Hospital North Midlands but is in fact a much wider problem that merits wider industry investigation and changes. Read the report relating to Peter Hussey Read the report relating to Stephen Oakes
  12. News Article
    COVID-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists in Hong Kong showed. The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said. SARS-CoV-2 spreads mainly through respiratory droplets -- spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists in China have said infectious virus in the stool of patients may also play a role in transmission. The finding “highlights the importance of long-term coronavirus and health surveillance and the threat of potential fecal-oral viral transmissions,” Siew Chien Ng, associate director of the university’s Centre for Gut Microbiota Research, said in the statement. Read full story Source: Bloomberg, 7 September 2020
  13. Content Article
    Michael was diagnosed with Crohn's disease at the age of 12 and had his first operation at 14. He died last weekend and was the same age as me. Our daughters were in the same year at secondary school together, and we got to know each other that way at first and then through our mutual interest in health care. When he awoke from an operation to discover he had a stoma bag, he didn't wallow. He bought items online to make it a 'smart' stoma bag to be able to get an alert when it was near full and provide useful data to his medical consultants. This was the type of person he was. Whenever I needed help in anything and asked him, he would unconditionally do everything he could to help, and never failed to deliver – I wish I had been able to do more for him. When he realised that thousands of other patients would be able to benefit from his smart ostomy bag, he tried to get innovation funding to develop and manufacture it at scale for the NHS. He tried over 40 times and received over 40 rejections. People on the other side of the Atlantic were able to see what the NHS couldn't, and 11 Health (he was the 11th person to have a bowel transplant) moved to the West Coast of the USA and grew quickly. He was 'patient in residence' at Stanford Medical school, one of the first such roles in the world. With the clinicians at Stanford, they created the Everyone Included programme, a joint initiative between clinicians and patients which as he described it is "a framework for healthcare innovation, implementation and transformation based on principles of mutual respect and inclusivity". He mentioned this and his journey as a patient in his Ted X talk in 2018. In that talk, he calls for a Chief Patient Officer to work with healthcare execs in co-designing new services for patients or improving existing services. Involving patients in this sort of work is a key foundation for safer healthcare systems. This is not a non-exec role, it is not an arms length committee tick box role. It is a role that can have a profound effect on the ways that services are delivered to patients. It is hugely important and no UK care providers has anyone like this on their exec teams. If you know different, please comment on it below. I think it is about time that a movement to appoint Chief Patient Officers into Trusts was started, don't you? See here for a detailed interview with Michael in 2018: https://www.highland-marketing.com/interviews/hm-interview-michael-seres/