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Content ArticleSubstantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. In a study published in the Lancet, McHugh et al. aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.
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News Article
Having minimum nurse to patient ratios cuts risk of death, new study claims
Patient Safety Learning posted a news article in News
New research examining the effect of minimum nurse-to-patient ratios has found it reduces the risks of those in care dying by up to 11%. The study, published in The Lancet, also said fewer patients were readmitted and they had shorter stays in hospital. It compared 400,000 patients and 17,000 nurses working in 27 hospitals in Queensland, Australia to 28 other hospitals. The state has a policy of just one nurse to every four patients during the day and one to seven at night, in a bid to improve safety and standards of care. The research said savings made from patients having a shorter length of stay, which fell 9%, and less readmissions were double the cost of hiring the extra nurses needed to achieve the ratios. NHS England has resisted moves towards minimum nurse to patient ratios, suspended work by the National Institute for Health and Care Excellence (NICE) on safe nurse staffing in 2015. This came as the watchdog was preparing to call for minimum ratios in accident and emergency departments. It has advised that eight or more patients to one nurse is the point at which harm can start to occur. Read full story Source: The Independent, 12 May 2021 -
News Article
New law to dissolve CCGs and curtail the internal market confirmed
Patient Safety Learning posted a news article in News
The government has confirmed its commitment to bring in new health legislation during this Parliament, but social care reform has again been ‘kicked into the long grass’. Today’s Queen’s Speech confirmed that planned, radical changes to the Health and Social Care Bill 2012 will be laid before Parliament this year. The changes, first outlined in the government’s proposals this February, will put integrated care systems on a statutory footing, dissolve clinical commissioning groups, water down the internal market within the NHS and increase the powers the health secretary has over NHS England and the service. Today’s Queen’s Speech said these changes meant “patients will receive more tailored and preventative care, closer to home [and will] empower the NHS to innovate and embrace technology”. However, it did not add any further information to the government’s already stated plans to “bring forward proposals in 2021” for social care reform. The 2019 Queen’s Speech, the first delivered during Boris Johnson’s tenure as prime minister, promised to bring in ”legislation for long-term social care reform in England”. To date, the government has failed to act on this promise. Read full story Source: HSJ, 11 May 2021 -
Content ArticleIn the Patients Association 2020 survey, patients told us about their experiences of living with health and care needs during the COVID-19 pandemic. Their testimony painted a bleak picture in many ways. This follow-up survey finds that many aspects of their experiences are not much better, and some are worse.
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EventSarah Miller, Director of Partnerships, Patient Safety Movement Foundation is joined by Ariana Longley, Chief Operating Officer of the PSMF to discuss how you and your loved ones can prepare before going into the hospital. Ariana highlights the importance of knowing possible risks and alternatives to proposed treatments, things you should bring to your hospital visit, and shares the free resources the Patient Safety Movement Foundation has to offer, both general and COVID-19 resources.
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News Article
Covid: Pregnant women in Wales 'still go it alone'
Patient Safety Learning posted a news article in News
Pregnant women are facing a postcode lottery over whether they can bring a partner to maternity appointments. Health boards were given flexibility in November to allow pregnant woman in low Covid rate areas to take their partners to maternity appointments. But many parts of Wales with the lowest rates are still forcing pregnant women to attend some appointments alone. There are calls, as lockdown eases, for partners Wales-wide to be allowed to all appointments and during labour. Emma Fear, 30, was not able to take her partner with her to hospital when she experienced bleeding during pregnancy in June last year and was told, alone, that she was losing her baby. She then had to repeat the news to her partner, who was waiting outside in the car. "At the time, he could have come and sat outside a pub with me, but he couldn't come with me when I'd had severe bleeding and knew I had probably lost my baby." Read full story Source: BBC News, 2 May 2021 -
Content ArticleThe Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it.
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Content ArticleThe Doctor Will Zoom You Now was a rapid, qualitative research study designed to understand the patient experience of remote and virtual consultations. The project was led in partnership with Traverse, National Voices and Healthwatch England and supported by PPL. The study engaged 49 people over 10 days (June 22nd – July 1st 2020) using an online platform, with 20 additional one to one telephone interviews. Participants were also invited to attend an online workshop on the final day of the study. Using insight from the key findings from the research, this website provides useful tools and tips for getting the most out of your appointment.
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Content Article
In this blog for the hub, Tim McLachlan, Chief Executive of the Natasha Allergy Research Foundation, highlights the lack of support available for patients and their families who spend their lives trying to keep either themselves or their children safe. To date there has been little attention, importance and investment given to NHS allergy services and this, he says, needs to change. -
Content ArticleWhile healthcare quality has been improving on average in OECD members countries, patient safety remains a central priority for policy makers and health care leaders. A growing research body has found that patient safety culture (PSC) is associated with numerous positive outcomes, including improved health outcomes, improved patient experience, and organisational productivity and staff satisfaction. Tools to measure PSC have proliferated in recent decades and are now in wide-spread use. This report includes findings from OECD countries on the state of the art for measurement practices related to PSC. Overall, measurement of PSC is prevalent across OECD countries, though the application, purpose, and tools vary. International learning and benchmarking has significant potential for better understanding and improvement of patient safety and health care quality.
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News Article
Eating disorders: families tube-feeding patients at home amid NHS bed shortage
Patient Safety Learning posted a news article in News
Extremely unwell eating disorder patients are having to be tube fed at home by their families owing to a lack of hospital beds, as the Royal College of Psychiatrists reports a rise in people being treated in units without specialist support. Leading psychiatrists are urging the government for an emergency cash investment as the pandemic has prompted a rise in demand for treatment for conditions such as anorexia, amid “desperate pressure in the system”. In interviews with the Guardian, a number of parents told of the struggles of helping a severely unwell person from home. A number of families said they had no choice but to tube feed their children at home daily. Other parents said their children had been admitted to general children’s wards, where they were being treated by staff who had no experience of eating disorders. It is unclear how many patients are being treated at home, but Agnes Ayton, the chair of the Eating Disorder Faculty at the Royal College of Psychiatrists, said she had heard of people being unable to find beds and being creative in the community: “There is desperate pressure in the system.” Read full story Source: The Guardian, 22 April 2021 -
Content Article
In his newsletter today (The Top 10 Dangers of Digital Health), the medical futurist, Bertalan Meskó, raises some very topical questions about the dangers of digital health. As a huge advocate of the benefits of digital health, I am aware of most of these but tend to downplay the negative aspects as I generally believe that in this domain the good outweighs the bad. However, as I was reading his article, I realised that it was written very much from the perspective of a clinician and, to some extent, a healthcare organisation too. The patient perspective was included but not from a patient safety angle. Many of the issues that he raises do have significant patient safety issues associated with them which I’d like to share in this blog. -
Content ArticleMissed or failure to follow up on test results threatens patient safety. This qualitative study from Dahm et al. used volunteers to explore consumer perspectives related to test result management. Participants identified several challenges that patients experience with test-results management, including systems-level factors related to the emergency department and patient-level factors impacting understanding of test results.
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Content ArticleIn this episode of Covid in the News, hosts Monique and Tom spoke to Ondine Sherwood, co-founder of patient advocacy and support group LongCovidSOS. They talk about the patient agenda, how community-driven research has changed since the start of the pandemic, Long Covid and policy, and the key questions to be answered in the coming months for longhaulers.
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Content ArticleTokophobia is an extreme fear of pregnancy and childbirth; it causes severe psychological distress and can have far reaching consequences. Despite this, tokophobia is under-researched and many healthcare professionals have never heard of it, explains Sarah-Jane Archibald in this BMJ Opinion article.
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Content ArticleDr Helen Simpson, Lisa Shepherd and Dr Steve Kell summarise the guidance and implementation of the steroid emergency card in primary care.
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News ArticleCoronavirus tests for patients in mental health hospitals should be couriered to testing labs and prioritised for results to prevent patients being forced to self-isolate for longer than is necessary, according to new guidance. NHS England has told mental health hospitals they need to use dedicated couriers for urgent swabs and tests should be specifically labelled for mental health patients so they can be turned around faster. Health bosses are worried thousands of patients in mental health wards could deteriorate ifare forced to self-isolate in their rooms for longer periods. More than 14,000 patients were being detained in hospital under the Mental Health Act in January 2021, with patients needing to be tested on admission to wards and if they show symptoms. Read full story Source: The Independent, 30 March 2021
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Content ArticleUK guidelines recommend that assessment and monitoring of breathless, unwell, or high risk patients with suspected COVID-19 should include pulse oximetry. Guidance published in January 2021 by the World Health Organization includes a provisional recommendation for “use of pulse oximetry monitoring at home as part of a package of care, including patient and provider education and appropriate follow-up. In this BMJ Practice article, Tricia Greenhalgh and colleagues discuss the remote management of COVID-19 using home pulse oximetry.
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News ArticleThat throbbing headache just won’t go away and your mind is racing about what may be wrong. But Googling your symptoms may not be as ill-advised as previously thought. Although some doctors often advise against turning to the internet before making the trudge up to the clinic, a new study suggests that using online resources to research symptoms may not be harmful after all – and could even lead to modest improvements in diagnosis. Using “Dr Google” for health purposes is controversial. Some have expressed concerns that it can lead to inaccurate diagnoses, bad advice on where to seek treatment (triage), and increased anxiety (cyberchondria). Previous research into the subject has been limited to observational studies of internet search behaviour, so researchers from Harvard sought to empirically measure the association of an internet search with diagnosis, triage, and anxiety by presenting 5,000 people in the United States with a series of symptoms and asked them to imagine that someone close to them was experiencing the symptoms. The participants – mostly white, average age 45, and an even gender split – were asked to provide a diagnosis based on the given information. Then they looked up their case symptoms (which, ranging from mild to severe, described common illnesses such as viruses, heart attacks and strokes) on the internet and again offered a diagnosis. As well as diagnosing the condition, participants were asked to select a triage level, ranging from “let the health issue get better on its own” to calling the emergency services. Participants also recorded their anxiety levels. The results showed a slight uptick in diagnosis accuracy, with an improvement of 49.8% to 54% before and after the search. However, there was no difference in triage accuracy or anxiety, the authors wrote in the journal JAMA Network Open. These findings suggest that medical experts and policymakers probably do not need to warn patients away from the internet when it comes to seeking health information and self-diagnosis or triage. It seems that using the internet may well help patients figure out what is wrong. Read full story Source: The Guardian, 29 March 2021
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News ArticleMany GPs find telephone appointments with patients frustrating and want to see them in person because they fear they will otherwise miss signs of illness , the leader of Britain’s family doctors has said. Prof Martin Marshall told the Guardian that remote consultations felt like working “in a call centre” and risked damaging the relationship between GPs and their patients. Telephone and video appointments had proved useful during the Covid pandemic, when GP surgeries limited patients’ ability to come in for face-to-face appointments, he said. However, while that helped limit the spread of coronavirus, “this way of working has been frustrating for some GPs, particularly when most consultations were being delivered remotely, who have felt like they’ve been delivering care via a call centre, which isn’t the job they signed up for." “Remote consultations have advantages, particularly in terms of access and convenience for patients. But we know that patients prefer to see their GP face to face." “Remote working has been challenging for many GPs, particularly when delivering care to patients with complex health needs,” said Marshall, who is a GP in London. “It can also make it harder to pick up on soft cues, which can be helpful for making diagnoses.” His remarks come as NHS leaders and doctors groups are discussing how far appointments should return to being in person now the pandemic is receding. Read full story Source: The Guardian, 28 March 2021
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News Article
Prioritising surgery inpatients for vaccinations may save lives, study suggests
Patient Safety Learning posted a news article in News
Tens of thousands of post-operative deaths could be avoided by ensuring patients are given coronavirus vaccines while waiting for elective surgery, a new study suggests. People awaiting surgery around the globe should thus be prioritised for COVID-19 jabs ahead of other groups, according to the research, funded by the National Institute for Health Research (NIHR). Studying data for 141,582 patients from across 1,667 hospitals in 116 countries – including Australia, Brazil, China, India, UAE, the UK and the US, scientists found that between 0.6 and 1.6% of patients have developed coronavirus in the wake of elective surgery. For patients who did contract COVID-19, their risk of death was four to eight times greater than typically seen in the 30 days after surgery. Given the higher risks that surgical patients face, scientists calculate that vaccines are more likely to have a life-saving impact upon pre-operative patients – particularly the over-70s and cancer patients – than among the general population. The researchers estimated that – in order to save one life in the course of a year – 351 people aged over 70 facing cancer surgery required vaccination. This figure rises to 1,840 among over-70s in general. “Pre-operative vaccination could support a safe restart of elective surgery by significantly reducing the risk of Covid-19 complications in patients and preventing tens of thousands of Covid-19-related post-operative deaths,” said co-lead author Aneel Bhangu, from the University of Birmingham. Read full story Source: The Independent, 25 March 2021 -
News Article
Daughter 'made to wait as mother died alone'
Patient Safety Learning posted a news article in News
An elderly woman died alone in a care home while her daughter was left waiting in a nearby room, an ombudsman says. When the daughter went into her mother's room at the Puttenham Hill House Care Home in Guildford, Surrey, she found she had died. The Local Government and Social Care Ombudsman said the care home had not protected the woman's dignity. Surrey County Council has apologised to the family for the distress caused. The council had arranged and funded the woman's care at the Bupa-run home. A Bupa spokesman said it had apologised to the family and introduced "comprehensive measures" to prevent such a situation happening again. The woman's daughter had complained she had been called too late to the care home when her condition deteriorated in August 2019. When she arrived she was left in a waiting area and not told her mother was seriously ill, the ombudsman said. When she went into her mother's room 15 minutes later it was apparent her mother had died, and she found dried blood on the floor and oxygen pipes in her mother's nose. The agency nurse looking after the woman never spoke to the daughter, the ombudsman said. An inquest found the woman died from a brain haemorrhage, which would have been difficult to spot. Michael King, Local Government and Social Care Ombudsman, said: "The daughter was not able to be with her mother as she died and her mother should not have been alone in the final moments of her life." Read full story Source: BBC News, 23 March 2021 -
Content ArticleSafety culture refers to the way patient safety is thought about, structured and implemented in an organisation. Safety climate is a subset of this, focused on staff attitudes about patient safety. In recent years, a great deal of research has explored ways to measure safety culture and safety climate in health care. There is a growing emphasis on interventions to improve organisational safety culture and staff attitudes towards safety. It is assumed that improving safety culture will directly or indirectly affect patient outcomes. This evidence scan examines whether there is any empirical evidence to support this assumption.
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News Article
Blanket 'do not resuscitate' orders imposed on English care homes, finds CQC
Patient Safety Learning posted a news article in News
Blanket orders not to resuscitate some care home residents at the start of the Covid pandemic have been identified in a report by England’s care regulator. A report published by the Care Quality Commission (CQC) found disturbing variations in people’s experiences of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the pandemic. Best practice is for proper discussions to be held with the person involved and/or their relatives. While examples of good practice were identified, some people were not properly involved in decisions or were unaware that such an important decision about their care had been made. Poor record-keeping, and a lack of oversight and scrutiny of the decisions being made, was identified. The report, 'Protect, respect, connect – decisions about living and dying well during Covid-19', calls for a ministerial oversight group – working with partners in health and social care, local government and the voluntary sector – to take responsibility for delivering improvements in this area. The report surveyed a range of individuals and organisations, including care providers and members of the public, and identified: Serious concerns about breaches of some individuals’ human rights. Significant increase in DNACPRs put in place in care homes at the beginning of the pandemic, from 16,876 to 26,555. 119 adult social care providers felt they had been subjected to blanket DNACPR decisions since the start of the pandemic. A GP sent DNACPR letters to care homes asking them to put blanket DNACPRs in place. In one care home a blanket DNACPR was applied to everyone over 80 with dementia. Read full story Source: The Guardian. 18 March 2021 -
Content ArticleCQC review of ‘do not attempt cardiopulmonary resuscitation’ decisions during the coronavirus (COVID-19) pandemic.
