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Community Post
GP experiences of rejected referrals and access to secondary care
Patient-Safety-Learning posted a topic in GP and primary care
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Are you a GP or other healthcare professional working in primary care? Have you noticed an increase in rejected referrals to outpatient services/for scans and other investigations? How have changes to the referral system affected you? What communication relating to referrals have you received recently from the NHS? What has the impact been on your own workload and wellbeing, and the safety of patients? Please share your experiences with us so we can continue to highlight this important issue. -
Content ArticleThis is the report and formal minutes of a House of Commons Public Accounts Committee session that examined the issues surrounding NHS backlogs and waiting times in England. The session particularly focused on accountability in how NHS England and the Department for Health and Social Care manage workforce and resources. At the end of December 2021, 6.07 million patients were waiting for elective care, the biggest waiting list since records began. Only 64% (3.87 million) of these patients had been waiting for less than 18 weeks, compared with the performance standard which requires 92% to have been waiting for less than 18 weeks. Similarly, in December 2021, only 67% of patients with an urgent referral for suspected cancer were treated within 62 days compared with a requirement for 85% to be treated within that time. The report highlights that although the Covid-19 pandemic had a significant effect on the backlog, NHS waiting time performance had declined steadily in the years before the pandemic.
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Content Article
Communication is key to building patient trust in ‘the system’
Lotty posted an article in Patient-centred care
In this blog, Lotty Tizzard, Patient Safety Learning's Content and Engagement Manager, looks at how positive, proactive communication improves patient trust in health services. She highlights that negative past experiences can prevent patients accessing the support and treatment they need, and looks at possible ways to build patient trust in the health system.- Posted
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Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation looked at the risks involved in the correct identification of patients in outpatient departments. Correct identification is crucial to make sure they receive the right clinical procedure. In the last 10 years the number of patients treated in outpatient clinics has nearly doubled. Many minor surgical procedures can now be carried out in an outpatient clinic, whereas in the past they would have been carried out in an inpatient theatre setting. The high number of patients treated in an outpatient clinic requires efficient management. Clinical consultation and delivery of the required intervention often needs to be completed within a 15-20-minute appointment. In a single outpatient waiting area there may be patients arriving for different clinical interventions. Staff need to make sure that all patients are seen in the right place, at the right time and (if required) receive the right procedure. Outpatients are not provided with any physical means that staff can use to identify them. This is different to inpatients where a wristband is worn following an initial check of the patient’s identity. Checking the identity of a patient in an outpatient department typically relies on staff speaking to patients. There is a risk of patients being missed or misunderstood due to the environment, work demands, language or cultural barriers.
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Content ArticleThe 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.
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Content ArticleIn 2019 the Royal College of Surgeons of Edinburgh (RCSEd) carried out a survey which evidenced the extent of non-consultant hospital doctors’ concerns about different aspects of their ability to deliver out of hours care. Respondents were also asked to give examples or aspirations of best practice. This report uses this survey data and examples of best practice to provide a proactive guideline to support trainee surgeons. The survey found that there were five key areas requiring improvement for nonconsultant hospital doctors when working OOH, specifically: a) electronic systems; b) supervision; c) training; d) staffing; e) facilities. This document considers the results of the survey to make recommendations on best practice that will support non-consultant hospital doctors and protect patients out of hours.
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Content Article
Prostate Cancer UK: Personalised stratified follow-up
Patient Safety Learning posted an article in Men's health
This cost-effective programme for personalised stratified follow-up delivers better outcomes for prostate cancer patients and has been shown to free up capacity in the follow-up pathway. The programme moves follow-up care from outpatient clinics to remote monitoring. Men who are eligible for remote follow up therefore don't need to attend routine appointments unless an issue arises. This web page gives advice, guidance and tools, and examples of hospital trusts that took part in the pilot. -
Content ArticleThe 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.
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Content ArticleMyalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is characterised by persistent and disabling fatigue, exercise intolerance, cognitive difficulty, and musculoskeletal/joint pain. Post-exertional malaise is a worsening of these symptoms after a physical or mental exertion and is considered a central feature of the illness. Scant observations in the available literature provide qualitative assessments of post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome. To enhance our understanding, Stussman et al. formed focus groups and listened to patients’ experiences to better understand post-extertional malaise. The authors found that the experience of post-exertional malaise in ME/CFS varies greatly between individuals and leads to a diminished quality of life. ME/CFS patients describe post-exertional malaise as all-encompassing with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover. Given the extensive variability in patients, further research identifying subtypes of post-exertional malaise could lead to better targeted therapeutic options.
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Content ArticleLeeds Hospital NHS Trust has developed a range of patient leaflets. These leaflets inform patients and relatives about the changes to their care and different processes during the pandemic.
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Content Article
Out-patient Parenteral Antibiotic Therapy (OPAT) is now a routine part of care in the UK following demonstration that it is safe and effective for patients and OPAT is now being actively promoted as part of the UK government’s stewardship initiatives. NHS North Tees and Hartlepool share their experience of redesigning their OPAT services. See the attachment below for details on the project. -
News Article
Covid sparks boom in digital hospital outpatient appointments
Patient Safety Learning posted a news article in News
Tens of thousands of outpatient video consultations have been carried out by NHS trusts following the national rollout of a digital platform to support the coronavirus response. Digital healthcare service Attend Anywhere was introduced across the country at the end of March after NHSX chief clinical information officer Simon Eccles called for its rapid expansion. There has been a major push to boost digital healthcare services across the country in order to support the national response to coronavirus. Much of primary care has already switched to working virtually. Undertaking hospital outpatient appointments digitally has been identified as a way of keeping patients safe by removing their need to travel. There have now been more than 79,000 consultations with Attend Anywhere. The number of consultations started at around 200 per day, but has rapidly increased to more than 6,000 per day. Data released by NHS Digital showed that GPs moved swiftly to change their practice model in the face of COVID-19. The proportion of appointments conducted face-to-face nearly halved and the proportion of telephone appointments increased by over 600 per cent from 1 March to 31 March as GPs moved to keep patients out of surgeries except when absolutely necessary. However, concerns have been raised over the limitation of remote appointments, particularly in mental health services. Royal College of GPs chair Martin Marshall raised concerns that video appointments could make it difficult for doctors to diagnose and manage patients’ conditions during the pandemic. Read full story Source: HSJ, 11 May 2020 -
News Article
COVID-19 health management service to care for patients at home
Patient Safety Learning posted a news article in News
NHS England is commissioning a “COVID-19 home treatment service” of primary and community healthcare for self-secluding patients. It is introducing “urgent primary care services to patients diagnosed with COVID-19” who are self-secluded at home. The service will care for patients’ symptoms relating to COVID-19 as well as other conditions until they are discharged from home isolation and referred back to their GP. “There is likely to be a gradual handover of patients to CHMS providers as they come onstream to provide the service,” according to a letter from NHSE’s primary care directors sent to GPs today. “As soon as the new service is up and running in your area, your clinical commissioning group will be able to tell you who will be providing care for patients in your locality.” Read full story (paywalled) Source: HSJ, 11 March 2020 -
News ArticlePatients were harmed at a Midlands trust because of delays in receiving outpatients and diagnostics appointments, the Care Quality Commission (CQC) has warned. Following the inspection at Northern Lincolnshire and Goole Foundation Trust in September and October last year, the CQC has lowered the trust’s rating in its safety domain from “requires improvement” to “inadequate”. It warned there were insufficient numbers of staff with the right skills, qualifications and experience to “keep patients safe from avoidable harm”. The report noted the trust had identified incidents in 2018 and 2019 where patients had come to harm due to delays in receiving appointments in outpatients, particularly in ophthalmology. Ten patients were found to have come to low harm, one patient moderate harm and two patients severe harm. The CQC also issued a Section 31 letter of intent to seek further clarification in relation to incidents where patients had come to harm because of delays to receiving appointments in outpatients and diagnostic imaging, although it has confirmed the trust has provided details on how it is going to manage the issues raised. The watchdog said it would continue to monitor the issue. Read full story (paywalled) Source: HSJ, 7 February 2020
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Content ArticlePrimary care services provide an entry point into the health system which directly impact's people well-being and their use of other healthcare resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organization (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, the majority of the work has been focused on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. The paper from Kuriakose et al., published in the Journal of Family Medicine and Primary Care, focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.
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Content ArticlePrimary care services provide an entry point into the health system which directly impact's people well-being and their use of other health care resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organisation (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, majority of the work has been focussed on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. This paper, published in The Journal of Family Medicine and Primary Care, focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.
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Content ArticleAntimicrobial resistance leads to increased morbidity, mortality and healthcare costs worldwide. In order to contain antimicrobial resistance, Antibiotic Stewardship Programs (ASP) have been developed to measure and improve the appropriateness of antimicrobial use. A common way to measure the appropriateness of antimicrobial use is by evaluating whether antimicrobials are prescribed according to local guidelines and if not available, to national or international guidelines.
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Content Article
Outpatient hysteroscopy: RCOG patient leaflet
Claire Cox posted an article in Women's health
This leaflet, produced by the Royal College of Obstetricians and Gynaecologists and the British Society for Gynaecological Endoscopy, is for individuals who have been offered hysteroscopy as an outpatient. It may also be helpful if you are a partner, relative or friend of someone who has been offered this procedure. -
News Article
Health strike: Action could delay cancer diagnoses
Patient Safety Learning posted a news article in News
Patients are facing a week of disruption, with more than 10,000 outpatient appointments and surgeries cancelled in Belfast. Some people referred by their GPs on suspicion of cancer could have their diagnosis delayed, the head of the Belfast Trust has said. The trust apologised, blaming industrial action on pay and staffing. Martin Dillon said outpatient cancellations "could potentially lead to a delay in treatment" for cancer. The Department of Health said the serious disruption to services was "extremely distressing". Read full story Source: BBC News, 2 Decmeber 2019 -
Content ArticleActive surveillance (AS) is an option in the management of men with low-stage, low-risk prostate cancer. These patients, who often require prolonged follow-up, can put a strain on outpatient resources. Nurses are ideally placed to develop advanced roles to help meet this increased demand—a model Martin et al. have utilised since 2014. The authors set about to comprehensively evaluate their nurse-led AS (NLAS) programme. The study found that nurse-led active surveillance is safe and effective. Patients and stakeholders alike held positive views of the programme.
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Content ArticleFollowing the inquest into the death of former patient Amy Allan and the subsequent Preventing Future Deaths report given to Great Ormond Street Hospital for Children, Chief Executive Matthew Shaw would like to outline how the hospital is learning from this and what action has been taken to address the concerns that have been raised.
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Community PostIncidents per 1000 bed days – what does this actually mean? How is this sum used to quantify incidents reported in an outpatient setting?
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