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Content ArticleOnline patient feedback is becoming increasingly prevalent on an international scale. However, limited research has explored how healthcare organisations implement such feedback. This research from Baines et al. sought to explore how an acute hospital, recently placed into ‘special measures’ by a regulatory body implemented online feedback to support its improvement journey.
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News Article
Public told not to delay cancer check-ups
Patient Safety Learning posted a news article in News
The public are being urged not to put off seeking help for worrying cancer symptoms because of NHS pressures. NHS England chiefs said record numbers were being seen for check-ups before Omicron hit - and despite the current situation cancer was being prioritised. There have been nearly 50,000 fewer cancer diagnoses across the UK since the start of the pandemic, Macmillan Cancer Support say. This risks an increase in late-stage diagnoses, reducing survival chances. Past surveys have suggested people are reluctant to come forward during surges in Covid cases because they did not want to be a burden to the health service. NHS England said record numbers had had urgent cancer check-ups in November when 246,000 saw a consultant after a referral by a GP - although just over three quarters of these were seen in the target time of two weeks. NHS England cancer director Dame Cally Palmer added it was vital people did not delay now even though hospitals were under huge strain. "NHS staff are working hard to ensure that those who are coming forward for checks can be seen quickly so that cancer can be caught at an earlier stage." She said common symptoms to look out for included diarrhoea that lasts for three weeks or more, new lumps or bumps and unexplained weight loss or fatigue. Read full story Source: BBC News, 2o January 2022 -
Content Article
Cervical cancer symptoms (Jo's Cervical Cancer Trust)
Patient Safety Learning posted an article in Women's health
Cervical cancer symptoms include vaginal bleeding that is unusual for you, changes to vaginal discharge, discomfort during sex and pain in your lower back or pelvis. If you have symptoms, you should contact your GP. -
News Article
Patients 'wait two years' for check-ups as dentists drop NHS work
Patient Safety Learning posted a news article in News
NHS dentistry is "hanging by a thread" with some patients facing two-year waits for check-ups, the British Dental Association has said. Department of Health data analysed by the BBC shows almost 1,000 dentists working in 2,500 roles across England and Wales left the NHS last year. One woman told how she had been in pain for more than a year while waiting to have root canal surgery. NHS England said patients who most needed care should be prioritised. Pamela Carr, 58, from Carlisle, has been looking for an NHS dentist to fix her root canal since November 2020. "I've become used to the pain," she said. "I can't afford the private care, and I've tried every practice within 30 miles. I phoned NHS England too." "They said there's nothing they can do because there are no NHS dentists. That was the end of the conversation." Clinical Commissioning Group North Cumbria, which covers the area, lost 4% of its dentists in the last year. The worst-affected area was NHS Portsmouth CCG, which lost 26% of its NHS dentists over 12 months. At least 10% of NHS dentists were lost in 28 other English CCGs. Read full story Source: BBC News, 19 January 2022 -
News Article
GPs should regularly review self-harm patients, says draft NICE guidance
Patient Safety Learning posted a news article in News
GPs should regularly review self-harm patients and offer a specific CBT intervention, according to a consultation on the first new guidance for self-harm to be drawn up in 11 years. The new draft guidance emphasises the importance of referring patients to specialist mental health services, but stresses that, for patients who are treated in primary care, continuity is crucial. If someone who has self-harmed is being treated in primary care, GPs must ensure regular follow-up appointments and reviews of self-harm behaviour, as well as a medicines review, the draft guideline say. They must also provide care for coexisting mental health issues, including referral to mental health services where appropriate, as well as information, social care, voluntary and non-NHS sector support and self-help resources. The guidance says that referring people to mental health services would ‘ensure people are in the most appropriate setting’. However, the committee agreed that ‘if people are being cared for in primary care following an episode of self-harm, there should be continuity of care and regular reviews of factors relating to their self-harm to ensure that the person who has self-harmed feels supported and engaged with services’. The draft guidance, out for consultation until 1 March, also says ambulance staff should suggest self-harming patients see their GP to maximise the chance of engagement with services. It says: ‘When attending a person who has self-harmed but who does not need urgent physical care, ambulance staff and paramedics should discuss with the person (and any relevant services) if it is possible for the person to be assessed or treated by an appropriate alternative service, such as a specialist mental health service or their GP.’ It notes that ‘ambulance staff often felt that the emergency department was not the preferred place that the person who had self-harmed wanted to be taken. They agreed that referral to alternative services could facilitate the person’s engagement with services’. Read full story Source: Pulse, 18 January 2022 -
Content ArticleThe Royal Society of Psychiatry are conducting a scoping and design exercise to identify the key actions that mental health providers can make to improve the use of the Mental Health Act (MHA) in preparation for the proposed MHA reforms, and to design two interventions to help mental health providers implement the identified actions. The broad aims of the exercise are to: Understand the experience of people currently and recently detained under the MHA Identify which aims identified in the Reforming the Mental Health Act White Paper (PDF) should be prioritised for a QI programme and intervention. Identify the key actions that mental health providers can make to improve use of the MHA. Design a QI programme and one other intervention in collaboration with staff and agencies involved in MHA treatment and detention.
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News ArticleNHS England has encouraged trusts to consider taking legal action against patients who refuse to leave hospital beds when step-down care is made available. NHSE guidance sent to trusts late last year, seen by HSJ, advised clinicians that where people “with mental capacity” refuse to vacate a bed because they do not accept NHS-funded short-term care offers, the “local discharge choice policy” should be followed, which could involve legal action. The guidance said the process “may include seeking an order for possession of the hospital bed” under civil law, and that “appropriate formal notification of the process must be given to the person and their representatives/carers”. These legal powers were open to trusts prior to covid, but the memo from NHSE comes amid increasing pressure on trusts to improve discharge rates, as waits for emergency and elective care continue to soar. Helen Hughes, chief executive of Patient Safety Learning, said: “Given the current pressures posed by covid, it is understandable that the NHS is seeking to ensure that the hospital discharge process is as swift and effective as possible. “However, hospital discharges are complex processes and can potentially result in avoidable harm if patients are discharged before they are clinically ready. It only takes one element of this complex process failing to put a patient’s safety at risk. “We would be particularly concerned if patients and their carers were put under pressure to accept potentially unsafe discharge options due to the threat of possible legal action by an NHS trust.” Read full story (paywalled) Source: HSJ, 14 January 2022
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News Article
NHSE orders health check blitz to stop mortality gap growing
Patient Safety Learning posted a news article in News
NHS England is urging health systems to ramp up physical health checks for people with severe mental illnesses to address a widening life expectancy gap caused by covid, according to a letter seen by HSJ. In a letter circulated to integrated care system leads, chairs, mental health and community trust executives on Wednesday, national commissioners warn the impact of the pandemic may widen current gaps in life expectancy for people with SMI and learning disabilities even further, without “decisive and proactive action”. The letter, circulated by national mental health director Claire Murdoch, learning disability and autism director Tom Cahill and inequalities director Bola Owolabi, quotes NHS data suggesting people with SMI are five-and-a-half times more likely to die prematurely and those with learning disabilities three times more likely to die from an avoidable cause of death. It says: ”The health inequalities faced by people living with SMI and people with a learning disability are stark… The impacts of the pandemic will widen this gap further unless we take decisive and proactive action to address inequalities… These checks are a key lever to address the reduced life expectancy for both groups.” It calls on primary care teams, already delivering thousands of covid vaccinations as part of the booster programme, to prioritise annual physical health checks alongside the rollout, “even as we continue with a level 4 national incident” caused by the omicron variant. Read full story (paywalled) Source: HSJ, 14 January 2022 -
News ArticleHospitals across Kent, Sussex and Surrey are being asked to discharge hundreds of patients who are well enough to leave by Friday. The head of NHS South East, Anne Eden, said the beds are needed to deal with an expected surge in admissions of people ill with the Omicron variant. The NHS nationally has agreed to a reduction of 30% of such patients based on the baseline figure of 13 December. South East hospitals are being asked to make a 50% reduction by 31 January. In a letter seen by the BBC, Ms Eden said: "This is in order to create the headroom to manage any further Covid pressures, with current modelling indicating a peak in Covid activity in mid-January." She wrote: "It is now critical that we redouble our efforts to discharge those patients who no longer require bedded care, to create capacity, improve flow and reduce the pressure on staff." Ms Eden said staff absences and the need to maintain delivery of critical care for patients mean the NHS "must continue to focus on creating the necessary capacity to meet demand". "Failure to do this will significantly increase the risk of a further rise in patient harm," she said. She said hospitals must work with partners, including social care providers, to achieve the reduction in the number of patients in hospital who were well enough to be discharged. Read full story Source: BBC News, 10 January 2022
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News Article
Patients at risk’ from ‘hastily rolled out virtual wards’
Patient Safety Learning posted a news article in News
NHS England’s plans to rapidly expand virtual wards are being ‘hastily rolled out’ and could put patients at risk while taking up significant staffing capacity, leading clinicians have warned. The Society for Acute Medicine and the Royal College of Physicians are among those who have raised concerns to HSJ about the huge increase in the use of the virtual wards model, under which patients are discharged home and given oximeters that fit on their finger so they can be remotely monitored by clinical staff. The concerns follow NHSE ordering trusts to ensure a minimum of 15% of hospital covid patients were being treated in virtual wards, in plans to help ease pressures on hospital wards announced just before Christmas. At the time NHSE announced the plans there were around 7,000 covid inpatients in English NHS hospitals, meaning around 1,000 patients should be in virtual wards. But the covid inpatient figure had more than doubled to nearly 16,000 by 5 January. The project is hugely significant because NHSE and trust chiefs want to use virtual wards much more widely – including for non-covid patients – and believe they represent a potentially game-changing option when it comes to alleviating pressure on hospitals and speeding up discharges. Many of the clinicians who spoke to HSJ were supportive of the principle of virtual wards but had serious concerns about the speed and timing of the rollout. They said there was a lack of evidence the approach was safe. Society for Acute Medicine president Tim Cooksley said virtual wards had potential for the future but that they “simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic”. Read full story (paywalled) Source: HSJ, 7 January 2022 -
News ArticleAmbulance trusts have begun asking patients with heart attacks and strokes to get a lift to hospital with family or friends instead of waiting for an ambulance, because of high covid absences and ‘unprecedented’ surges in demand, HSJ has learned. An internal note at North East Ambulance Service Foundation Trust said that where there was likely to be a risk from the delay in an ambulance reaching a patient, call handlers should “consider asking the patient to be transported by friends or family”. This applies to calls including category two, which covers suspected strokes and heart attacks, according to the note seen by HSJ. It said call handlers should “consider all forms of alternative transport” for patients. The note from medical director Mathew Beattie gives the example of a person with chest pain who would normally get a category 2 response – with a target of reaching them within 18 minutes – but where the ambulance response time would be two hours. In the message to staff, Dr Mathew Beattie said: “To manage [current] unprecedented demand, we have no other option than to try and work differently which I am aware will not sit comfortably but is absolutely essential if we are to sustain a service to those who need it most." “We need to weigh up the risk of delays for ambulances against alternative disposition or transport options. Where such risks are considered, I want you to be aware that the trust will fully support you in your decision-making under these circumstances.” Read full story (paywalled) Source: HSJ, 4 January 2022
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Content ArticleThis International Patient Summary roadmap (G7-IPS) supports the G7 commitment to deliver on the rights of patients to have access to their health information, and through using open and interoperable standards it enables this information to be used at the point of treatment or care. The roadmap outlines the component parts required for implementation and the standards which will be used to ensure alignment and interoperability across the G7 community. Although developed by the G7 countries, other countries, should they wish to, will be able to adopt the same principles and use the open and interoperable resources.
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Content ArticlePatients are increasingly encouraged to be active participants in managing their own health. New technologies, cultural shifts, trends in healthcare delivery and policies have brought the patients’ role in healthcare to the forefront. This session from the Chartered Institute of Ergonomics and Human Factors (CIEHF) reviews and advances the emerging discipline of Patient Ergonomics. It focuses on patients and their performance. It presents practical recommendations and case studies useful for researchers and practitioners and covers diverse healthcare settings outside hospitals and clinics, providing a combination of foundational content and specific applications.
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Content ArticleThis paper, published in the Journal of Health Services Research & Policy, examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. In their conclusion, the authors state that this study demonstrates the value of using patient complaints to supplement, test and challenge staff reports, including to provide greater insight on the many potential factors that may cause unsafe care.
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Content ArticleLindsey's doctor was so focused on the 52 pounds she'd gained during her third trimester, she missed a pregnancy disorder that could have killed Lindsey and her unborn child. Watch Lindsey's video where she talks about her experience and why it is important to find a doctor who respects you and who you can trust.
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News Article
US Patients can order ‘don’t weigh me’ cards to take to doctors
Patient Safety Learning posted a news article in News
Patients in the US are able to order “don’t weigh me” cards to take to the doctors in a move aimed at reducing anxiety and stress on a visit. The US group behind the initiative said being weighed and talking about weight “causes feelings of stress and shame for many people”. The cards say: “Please don’t weigh me unless it is (really) medically necessary.” It adds: “If you really need my weight, please tell me why so that I can give you my informed consent”. On the other side, it explains why the patient may not want to be weighed, including “when you focus on my weight I get stressed” and “weighing me every time I come in for an appointment and talking about my weight like it’s a problem perpetuates weight stigma”. It also says most health conditions can be addressed without knowing the patient’s weight. Public Health England guidance to health and care professionals says they are in a “unique position to talk to patients about weight management to prevent ill-health” and recommends brief interventions. It says the first step in a brief intervention over a patient’s weight is to weigh and measure them. “You should view this as a normal part of a routine consultation,” it says. Read full story Source: The Independent, 23 December 2021 -
News Article
The paramedics keeping patients out of hospital
Patient Safety Learning posted a news article in News
Chest pains for a 63-year-old man might typically mean a hospital trip to check it out. But after Clive Pietzka's 999 call, an advanced paramedic practitioner carried out tests and discharged him. The Welsh Ambulance Service Trust (WAST) job is one of those in a growing team who work to keep people out of hospital. Solutions like this are being sought following ambulance queues for hospital and worst ever performance figures. Mr Pietzka, from Barry, who has a heart problem, said initially he did not want to call an ambulance because of high demand. "They're very busy with Covid and everything else. But the GP practice said to call 999," he said. However, on this occasion a rapid response vehicle - a car with a single paramedic - came within 15-20 minutes and tests were performed, without a hospital trip. Advanced paramedic practitioner John McAllister who attended said he sees people more medical low acuity cases rather than emergency and trauma conditions. "I use assessment techniques and diagnostic tools to assess patients, formulate a diagnosis then put a plan in place," he said. "It's about trying to treat them at the right time and the right place, without having to take them to A&E." Adding to the pressure of the pandemic and winter demand, a shortage of social care workers to support patients' safe discharge means a large number of patients find themselves in hospital longer than medically necessary. The knock-on impact means it is becoming harder for new patients to be treated and admitted. Penny Durrant, the service manager for the clinical support desk at WAST regional headquarters in Cwmbran, said current challenges had led to growth in her team. She said it was a "recognition of needing to do something different". Read full story Source: BBC News, 21 December 2021 -
Content ArticleDalila, who lives in Cardiff, was diagnosed with systemic lupus erythematosus during childhood. In this blog for Lupus Awareness Month she talks about her experiences with the condition and the differences in the care she’s received between England and Wales. The experience of people like Dalila is why the Rare Autoimmune Rheumatic Disease Alliance are calling for change in how people with rare autoimmune rheumatic diseases are cared for in Wales. They are calling for: A properly commissioned specialised centre for rare autoimmune rheumatic diseases in Wales. A network, where this specialised centre can support local hospitals to deliver better care. Urgent action to resolve workforce issues in rheumatology in Wales.
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Content Article
Pfizer: Medicine safety tips for patients
Patient Safety Learning posted an article in Medication
Medication errors can happen in clinics and hospitals, pharmacies, and at home. Patients and healthcare providers, however, can work together to help prevent these errors. See Pfizer's tips for patients. -
Content Article
The 12 days of digital patient safety
Clive Flashman posted an article in Digital health and care service provision
A couple of weeks ago, I presented some of the ideas I’ve had around digital clinical safety. This was seasonally branded, ‘The 12 days of Digital Patient Safety’. The 12 issues that were on my list comprised: AI – regulation, ethics and testing. Patient safety not built into the innovation process (co-design and co-production with patients is required). Patient safety (in use) not effectively built into the digital health compliance systems. Poor user experience (design). The safety of medical devices, e.g. remote hacking. Privacy and consent around data. Fragmentation of patient records and data. Lack of interoperability. Cybersecurity. Patient digital and health literacy. Clinician attitudes and knowledge of digital technologies. The barriers to EHR integration (and poor use of patient-generated data). There was only time on the webinar to cover points 2, 3, 6 and 10; I hope that we can have further session in 2022 where we can discuss the others. -
Content ArticleFailure to rescue (FTR) denotes mortality from post-operative complications after surgery with curative intent. High-volume, low-mortality units have similar complication rates to others, but have lower FTR rates. Effective response to the deteriorating post-operative patient is therefore critical to reducing surgical mortality. Resilience Engineering might afford a useful perspective for studying how the management of deterioration usually succeeds and how resilience can be strengthened.
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Content ArticleHistorically, patients have always been considered the passive recipients of healthcare. This way of thinking affected everything from how people were cared for in a clinician’s office or hospital bed, to how they participated in clinical trials. It’s also meant that patients have previously had no role in the production or review of medical literature after research has been completed. However, this is changing, and now patients and members of the public are increasingly involved in new and meaningful ways at more steps in the research process, including as potential reviewers of medical papers. This has enormous benefits for science and healthcare. But patients and members of the public are not always provided with the relevant resources to participate effectively and efficiently, and this is something that journals need to work on.
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Content ArticleThe Code Red campaign aims to shine a light on the impact of sickle cell disease (SCD) in the UK by putting those with the condition at centre stage. Dunstan, Laurel, Philip and Zainab feature as campaign ambassadors and tell their individual stories of what it's really like to live with sickle cell.
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News Article
UK health trusts suspend home birth services as midwives shortage deepens
Patient Safety Learning posted a news article in News
A severe shortage of midwives has led to home birth services being closed or reduced by a number of hospital trusts across the UK, with pregnant women frequently left in limbo as to where they will be able to give birth. The Observer has found more than 20 trusts that have had disrupted home birth services in the past three months. Eight confirmed their services remain suspended due to staff shortages. They include East Kent Hospitals, Swansea Bay University Health Board and NHS Dumfries and Galloway – all of which report that the situation is under constant review. Home birth services at some trusts, such as Walsall Healthcare NHS Trust and University Hospitals of Derby and Burton, have been closed since August. Others have reopened after short suspensions or have written to expectant parents to say they cannot guarantee sending a midwife when there is high demand or staff shortages. The findings come a week after midwives across Britain staged protests to call on the government to address the “crisis” in maternity care, with staff suffering from chronic burnout and stress. Midwives are being driven out of the NHS by understaffing and fears they cannot deliver safe care, according to a recent survey published by the Royal College of Midwives (RCM). Maria Booker, programmes director at the charity Birthrights, said: “Staffing pressures in maternity services are very real right now. But for many women the option to give birth at home is not a luxury but the only option that feels safe to them." “Some know they will labour better at home while some do not want to visit hospital during a pandemic. Others have a had a previous traumatic hospital birth. We cannot just accept that home birth and other choices go out the window every time a maternity service is squeezed.” Read full story Source: The Guardian, 28 November 2021 -
Content ArticleThis report by the Healthcare Safety Investigation Branch (HSIB) has been published as part of a local pilot, which has been launched to evaluate HSIB’s ability to carry out effective investigations occurring between specific hospitals and trusts. After an evaluation, it will be decided whether this model can be implemented more widely by HSIB. This investigation reviewed the case of a woman who was taken to an emergency department by ambulance in April 2021, following a 999 call from her Granddaughter to the emergency operations centre. The emergency operations centre used the wrong NHS number for the patient, which was assigned to her for the duration of her stay in hospital and led to her being offered incorrect medication.
