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Content ArticleMany cross-sectional studies and reviews have demonstrated that higher registered nurse staffing levels are associated with better patient outcomes. The aim of this study was to identify and assess the evidence for an association between nurse staffing levels, including the composition of the nursing team, and patient outcomes in acute care settings from longitudinal studies.
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Content ArticleInstitutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical scrutiny, and serious discussion. This paper focuses on the racialised experiences of nurses and midwives during their education in UK universities, including their practice placements. It explores the emotional, physical, and psychological impacts of these experiences. The study concludes that the endemic culture of racism in nurse and midwifery education is a fundamental factor that must be recognised and called out. The study argues that universities and health care trusts need to be accountable for preparing all students to challenge racism and provide equitable learning opportunities that cover the objectives to meet the Nursing and Midwifery Council (NMC) requirements to avoid significant experiences of exclusion and intimidation.
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Content ArticleThe aim of this Australian study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.
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Content ArticleThe implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.
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Content ArticleFor decades the NHS has collected routine data on millions of patients. In a world where big data has increasing value, the UK has an opportunity to truly leverage its health data assets to benefit people in the UK and across the world—both through better health and through the generation of more research and development and economic growth. This report by the Institute of Global Health Innovation at Imperial College London provides a broad overview of the UK’s health data policy landscape. It identifies strategic and technical recommendations to move towards a health data policy ecosystem that allows clinical, societal or financial value to be more readily extracted from patient data.
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Content ArticleDuring the first waves of the Covid-19 pandemic, the UK shielding policy was introduced with the intention to protect people at the highest risk of harm from Covid-19 infection. This study in the journal Public Health aimed to describe intervention effects in Wales at one year. The authors retrospectively compared linked demographic and clinical data for cohorts of people identified for shielding from 23 March to 21 May 2020 with the rest of the population. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). The study found that: Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders, but lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Content Article
In this blog, Patient Safety Learning considers key patient safety issues relating to complications from surgical mesh implants, highlighting further sources of opinion and research on the hub. -
Content ArticleFailure to rescue is defined as mortality after complications during hospital care. Incidence ranges 10.9%–13.3% and several national reports such as National Confidential Enquiry into Patient Outcomes and Death and National Institute of Clinical Excellence CG 50 highlight failure to rescue as a significant problem for safe patient care. To avoid failure to rescue events, there must be successful escalation of care. Studies indicate that human factors such as situational awareness, team working, communication and a culture promoting safety contribute to avoidance of failure to rescue events. Understanding human factors is essential to developing work systems that mitigate barriers and facilitate prompt escalation of care. This qualitative evidence synthesis identifies and synthesise what is known about the human factors that affect escalation of care.
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Content ArticleCentral line–associated bloodstream infections (CLABSI) account for many harms suffered in healthcare and are associated with increased costs and disease burden. Central line rounds, like medical rounds, are a multidisciplinary bedside assessment strategy for all active central lines on a unit. The project team designed a HIPAA-protected, text-based process for assessing central lines for risk factors contributing to infection. Staff initiated a consultation via a virtual platform with an interdisciplinary team composed of oncology and infectious disease experts. The virtual discussion included recommendations for a line-related plan of care.
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News Article
Vaccinated less likely to develop Long Covid
Patient Safety Learning posted a news article in News
People who are vaccinated are less likely to develop Long Covid even if they catch the virus, a rapid review by the UK Health Security Agency reveals. It looked at the available evidence to date from 15 studies around the world. The findings suggest that while some who are jabbed catch Covid, vaccines reduce infection risk and illness, including symptoms like fatigue. And unvaccinated people who catch Covid and get symptoms of Long Covid, do better if they then get vaccinated. Vaccine effectiveness against most Long-Covid symptoms was highest in people aged 60 years and over In people who already had Long Covid symptoms, it found that vaccines may improve rather than worsen Covid symptoms, either immediately or over several weeks According to the UK Health Security Agency (UKHSA), around 2% of the UK population have reported symptoms of Long Covid, such as fatigue, shortness of breath and muscle or joint pain. Symptoms like these can last for more than four weeks after the infection. Read full story Source: 15 February 2022 -
News Article
Heart-disease risk soars after COVID — even with a mild case
Patient Safety Learning posted a news article in News
Even a mild case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after diagnosis, a new study1 shows. Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from COVID-19 than in similar people who hadn’t had the disease. What’s more, the risk was elevated even for those who were under 65 years of age and lacked risk factors, such as obesity or diabetes. “It doesn’t matter if you are young or old, it doesn’t matter if you smoked, or you didn’t,” says study co-author Ziyad Al-Aly at Washington University in St. Louis, Missouri, and the chief of research and development for the Veterans Affairs (VA) St. Louis Health Care System. “The risk was there.” People who had recovered from COVID-19 showed stark increases in 20 cardiovascular problems over the year after infection. For example, they were 52% more likely to have had a stroke than the contemporary control group, meaning that, out of every 1,000 people studied, there were around 4 more people in the COVID-19 group than in the control group who experienced stroke. The risk of heart failure increased by 72%, or around 12 more people in the COVID-19 group per 1,000 studied. Hospitalization increased the likelihood of future cardiovascular complications, but even people who avoided hospitalization were at higher risk for many conditions. “I am actually surprised by these findings that cardiovascular complications of COVID can last so long,” Hossein Ardehali, a cardiologist at Northwestern University in Chicago, Illinois, wrote in an e-mail to Nature. Because severe disease increased the risk of complications much more than mild disease, Ardehali wrote, “it is important that those who are not vaccinated get their vaccine immediately”. Read full story Source: Nature, 10 February 2022 -
News Article
7,469 research nurses and midwives across the UK and Ireland, new census reveals
Patient Safety Learning posted a news article in News
There are at least 7,469 research nurses and midwives across the UK and Ireland working within all areas of healthcare, reveals a landmark new census initiated by a group of NIHR 70@70 Senior Nurse & Midwife Research Leaders. The census, incorporating responses from research nurses and midwives across all four UK nations and the Republic of Ireland, reveals nurses and midwives are working at every level in healthcare from Bands 5 – 9 in the UK, and from staff nurse to Directors of Nursing or Midwifery in the Republic of Ireland. This suggests there are opportunities to join the profession at every level, with continued potential for career progression. Clinical research nurses and midwives are a specialist workforce, with knowledge, skills and expertise in both clinical practice and research delivery. The census shows that: 33.7% reported working in joint posts, for example as a clinical research nurse for part of their role as well as a clinical nurse specialist; 72% are working within a single disease/area specialism; 28% reported covering multiple disease areas. NIHR Director of Nursing & Midwifery Professor Ruth Endacott said: “This census reveals the true breadth and depth of our research nursing and midwifery community. We know there are scores of people working incredibly hard day and night helping to bring us new treatments and medicine alongside their healthcare colleagues but we now have a much clearer idea of the size of the workforce. Research nurses and midwives are making a difference to the health of people across the UK and Ireland." Read full story Source: National Institute for Health Research, 9 February 2022 -
News ArticleThe class B drug ketamine could help to treat people suffering from severe suicidal thoughts, a study has suggested. Researchers from the University of Montpellier in France said the sedative could save lives, as it appears to alleviate dark thoughts in patients admitted to hospital for their mental health. The finding was based on a controlled trial involving 156 adults with severe suicidal ideas, which ran from April 2015 to March 2019 in seven French teaching hospitals. The participants included people with bipolar disorder and major depressive disorder. However, patients with a history of schizophrenia were excluded from the study. Although the team found the side effects of ketamine were minor and had diminished by day four, they cautioned that more research was needed to examine its benefits. “Ketamine is a drug with a potential for abuse. Longer follow-up of larger samples will be necessary to examine benefits on suicidal behaviours and long term risks,” they wrote. Commenting on the study, Riccardo De Giorgi, a PhD student at the University of Oxford, said: "These findings indicate that ketamine is rapid, safe, and effective in the short term for acute care in hospitalised suicidal patients.” Read full story Source: The Independent, 4 February 2022 Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial
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News Article
New research hints at 4 factors that may increase chances of Long Covid
Patient Safety Learning posted a news article in News
It is one of many mysteries about Long Covid: Who is more prone to developing it? Are some people more likely than others to experience physical, neurological or cognitive symptoms that can emerge, or linger for, months after their coronavirus infections have cleared? Now, a team of researchers who followed more than 200 patients for two to three months after their Covid diagnoses report that they have identified biological factors that might help predict if a person will develop long Covid. The study, published by the journal Cell, found four factors that could be identified early in a person’s coronavirus infection that appeared to correlate with increased risk of having lasting symptoms weeks later: The level of coronavirus RNA in the blood early in the infection, an indicator of viral load. The presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. The reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant. Having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of Long Covid. The researchers said they had found that there was an association between these factors and Long Covid whether the initial infection was serious or mild. They said that the findings might suggest ways to prevent or treat some cases of Long Covid, including the possibility of giving people antiviral medications soon after an infection has been diagnosed. “I think this research stresses the importance of doing measurements early in the disease course to figure out how to treat patients, even if we don’t really know how we’re going to use all that information yet,” said Jim Heath, the principal investigator of the study. However, the study authors and other experts cautioned that the findings were exploratory and would need to be verified by considerably more research. Read full story (paywalled) Source: The New York Times, 25 January 2022 -
News Article
NHSE review accuses outstanding trust of ‘dismissive’ attitude to whistleblowers
Patient Safety Learning posted a news article in News
The leadership of a prominent cancer trust acted in a ‘defensive and dismissive’ manner when serious concerns were raised about bullying behaviours and multiple failings in the handling of a major research contract, an external review has found. As previously revealed by HSJ, NHS England commissioned the review into events at The Christie Foundation Trust after whistleblowers raised numerous concerns over a research project with pharmaceutical giant Roche, and about the way they were treated as a result of speaking out. The NHSE review, which was led by Angela Schofield, chair of Harrogate and District FT, was published earlier today within trust board papers. It described the trust’s research division as “ineffective” and said it had “allowed inappropriate behaviours to continue without challenge”. The review added: “It may… be thought to be surprising that NHSE/I found it necessary to commission an external rapid review to look into concerns which had been raised by colleagues within the research and innovation division." “The root cause of this seems to be an apparent failure by those people in leadership positions who were aware of the concerns that had been raised, in the circumstances covered by the review, to listen to and take notice of a number of people who have some serious issues about the way they are treated and wish to contribute to an improvement in the culture." It also summarised the experiences of 20 current and former staff members who said they suffered “detriment as a result of raising concerns”, although it did not make a clear judgement on whether their claims were justified. They said: “An experience of bullying, harassment and racial prejudice was described along with lack of respect at work… Patronising behaviour, humiliation and verbal aggression by managers and clinicians in public and private spaces contributed to the perception that working environments were emotionally unsafe.” Read full story (paywalled) Source: HSJ, 27 January 2022 -
News Article
Period changes after Covid jabs are short-lived
Patient Safety Learning posted a news article in News
Small changes to periods can follow a Covid vaccine but they quickly return to normal, a leading UK menstruation expert has said. Dr Victoria Male, from Imperial College London, called studies from the US and Norway which tracked women's cycles "reassuring". And she blamed misinformation for fuelling concerns over infertility. The Medicines and Healthcare products Regulatory Agency (MHRA) says there is no evidence Covid vaccines affect the ability to have children. The MHRA has received more than 37,000 reports of unexpected vaginal bleeding, heavier and delayed periods after a Covid jab. It has always said there is no evidence of a link to the vaccine, because women's cycles vary naturally - but scientists called for more research. Dr Male said: "Changes to the menstrual cycle do occur following vaccination - but they are small compared with natural variation and quickly reverse." Women's concerns arose "from misinformation that Covid-19 vaccines cause female infertility", she said. And more studies of pregnancy rates in couples trying to conceive were needed to make it clear they do not. A Covid infection, however, "may reduce sperm count and quality" - and understanding more about that would mean patients could be given the right advice. Read full story Source: BBC News, 27 January 2022 -
News Article
Long Covid: doctors find ‘antibody signature’ for patients most at risk
Patient Safety Learning posted a news article in News
Doctors have discovered an “antibody signature” that can help identify patients most at risk of developing long Covid, a condition where debilitating symptoms of the disease can persist for many months. Researchers at University hospital Zurich analysed blood from Covid patients and found that low levels of certain antibodies were more common in those who developed long Covid than in patients who swiftly recovered. When combined with the patient’s age, details of their Covid symptoms and whether or not they had asthma, the antibody signature allowed doctors to predict whether people had a moderate, high or very high risk of developing long-term illness. “Overall, we think that our findings and identification of an immunoglobulin signature will help early identification of patients that are at increased risk of developing long Covid, which in turn will facilitate research, understanding and ultimately targeted treatments for long Covid,” said Onur Boyman, a professor of immunology who led the research. Read full story (paywalled) Source: The Guardian, 25 January 2022 -
News Article
Doctors warn hospitals ‘not coping’ as study links A&E waits to deaths
Patient Safety Learning posted a news article in News
Hospitals are not able to cope with current pressures, senior doctors have warned, as a new study links long A&E waits to an increased risk of death. Patients waiting more than five hours within an emergency department are at an increased risk of dying, according to a study published in the Emergency Medicine Journal (EMJ). The study’s findings come as emergency care performance across England continues to deteriorate, and as pressures across hospitals mean that more patients are waiting for more than four hours in A&E departments than ever before. According to the research, death rates for patients waiting between six and eight hours before admission to hospital were 8% higher, and they were 10% higher for those waiting eight to 12 hours. The study was based on data collected prior to the pandemic, and national A&E waiting times have since deteriorated further. In November last year, the Royal College of Emergency Medicine (RCEM) warned that long delays and overcrowding in A&Es may have caused thousands of deaths during the pandemic. Researchers said that although cause and effect could not be established between longer waits and deaths after 30 days of hospital admission, they recognised a statistically significant trend. The paper said: “Long stays in the emergency department are associated with exit block and crowding, which can delay access to vital treatments. And they are associated with an increase in subsequent hospital length of stay, especially for older patients. Read full story Source: The Independent, 19 January 2022 -
News ArticleThere is no significant relationship between the number of managers or the amount spent on management and the quality of NHS hospital services, research has concluded. Researchers at the London School of Economics studied the performance of all 129 non-specialist acute trusts between 2012-13 and 2018-19. They measured hospital performance on five indicators covering financial position, elective and emergency waiting times, level of admissions and mortality. This was then compared to the number of managers each trust employed and the amount spent on management staff. The researchers also attempted to measure the quality of management based on answers given to relevant questions in the annual NHS staff survey. Reviewing the evidence they analysed, the LSE team state: “We find no evidence of an association between our measures of quantity of managerial input and quality of management… Furthermore, we find no associations between our measures of quantity of management input and five measures of hospital performance.” They add: “This holds, irrespective of how we define managerial input, whether by number of managers or expenditure on management. These results are generally robust to how we account for variation between hospitals and within hospitals over time.” This leads the researchers to conclude: “Hospitals hiring more managers do not see an improvement in the quality of management leading to better performance, and increasing the numbers of managers does not appear to improve hospital performance through any other direct or indirect mechanism.” Read full story (paywalled) Source: HSJ, 17 January 2022
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News ArticleThe debilitating disease multiple sclerosis could be caused by the common virus behind "kissing disease", scientists claim. A new study from Harvard University suggests the chronic disease could be from an infection of Epstein-Barr, a herpes virus that causes infectious mononucleosis. Mono or glandular fever, as it’s otherwise known, is colloquially known as "the kissing disease" for being highly contagious through saliva. While causing fatigue, fever, rash, and swollen glands, researchers propose that the Epstein-Barr virus could also establish a latent, lifelong infection that may be a leading cause of multiple sclerosis. Affecting 2.8 million people, there is no known cure for the chronic inflammatory disease of the central nervous system. “The hypothesis that EBV causes MS has been investigated by our group and others for several years, but this is the first study providing compelling evidence of causality,” the study’s senior author Alberto Ascherio, a professor of epidemiology and nutrition at Harvard Chan School, said in a press release. “This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection, and that targeting EBV could lead to the discovery of a cure for MS.” Read full story Source: The Independent, 13 January 2022
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News Article
Covid in pregnancy linked to birth-related complications
Patient Safety Learning posted a news article in News
A new study has linked COVID-19 to complications during pregnancy. Scottish researchers found that women who catch the virus near the end of pregnancy were more vulnerable to birth-related complications. They are more likely to suffer them than women who catch Covid in early pregnancy or not at all. The researchers say getting vaccinated is crucial to protect pregnant women and their babies from life-threatening complications. The latest findings come from the Covid in Pregnancy Study (Cops), which carried out research across Scotland to learn about the incidence and outcomes of Covid-19 infection and vaccination in pregnancy. It is one of the first national studies of pregnancy and Covid. They found that preterm births, stillbirths and newborn deaths were more common among women who had the virus 28 days, or less, before their delivery date. The majority of complications occurred in unvaccinated women. The results, which have been published in Nature Medicine, come after recent data showed 98% of pregnant women admitted to UK intensive care units with coronavirus symptoms were unvaccinated. Researchers are now calling for measures to increase vaccine uptake in pregnant women. Read full story Source: BBC News, 13 January 2022 -
News Article
Study suggests coronavirus lingers in organs for months
Patient Safety Learning posted a news article in News
Data from a new study suggests that the coronavirus that causes COVID-19 can persist in different parts of the body for months after infection, including the heart and brain. Scientists at the National Institutes of Health (NIH) found the virus can spread widely from the respiratory tract to almost every other organ in the body and linger for months. The researchers described the study as the "most comprehensive analysis to date" of the virus's persistence throughout the body and brain. They performed autopsies on 44 patients who died either from or with COVID-19 to map and quantify virus distribution across the body. Daniel Chertow, principal investigator in the NIH’s emerging pathogens section, said along with his colleagues that RNA from the virus was found in patients up to 230 days after symptom onset. The findings, released in a pre-print manuscript, shed new light on patients who suffer from Long Covid. The study found that the virus had replicated across multiple organ systems even among patients with asymptomatic to mild COVID-19. While the "highest burden" of infection was in the lungs and airway, the study showed the virus can "disseminate early during infection and infect cells throughout the entire body,” including in the brain, as well as in ocular tissue, muscles, skin, peripheral nerves and tissues in the cardiovascular, gastrointestinal, endocrine and lymphatic systems. "Our data support an early viremic phase, which seeds the virus throughout the body following pulmonary infection," the researchers wrote. Read full story Source: The Hill, 27 December 2021 -
News Article
Mass rapid tests in Liverpool cut hospital stays by a third
Patient Safety Learning posted a news article in News
Mass lateral flow testing cut the number of people needing hospital treatment for Covid by 32% and relieved significant pressure on the NHS when the measures were piloted last year, a study has shown. Liverpool conducted the first city-wide testing scheme using rapid antigen tests in November last year, amid debate about whether or not lateral flow tests (LFTs) were accurate enough to detect the virus in asymptomatic carriers. It expanded the project to cover the whole of the Liverpool region, offering people LFTs whether or not they had symptoms. Key workers did daily tests before going to work to show they were not infectious. Now an analysis has shown that it was more successful than Liverpool’s scientists and public health teams had anticipated, after they compared Covid cases and outcomes in the region with other parts of England. Professor Iain Buchan, dean of the Institute of Population Health, who led the evaluation, said: “This time last year, as the Alpha variant was surging, we found that Liverpool city region’s early rollout of community rapid testing was associated with a 32% fall in Covid-19 hospital admissions after careful matching to other parts of the country in a similar position to Liverpool but without rapid testing. “We also found that daily lateral flow testing as an alternative to quarantine for people who had been in close contact with a known infected person enabled emergency services to keep key teams such as fire crews in work, underpinning public safety.” Read full story Source: The Guardian, 19 December 2021 -
News Article
People hospitalised with COVID-19 are likely to face a limited recovery
Patient Safety Learning posted a news article in News
People who were hospitalised with COVID-19 and continued to experience symptoms at five months show limited further recovery one year after hospital discharge, a key finding of the Post-hospitalisation COVID-19 study (PHOSP-COVID) has revealed. The NIHR/UKRI-funded study, led by the NIHR Leicester Biomedical Research Centre, also confirmed that people who were less likely to make a full recovery from COVID-19 were female, obese, and required invasive mechanical ventilation (IMV) to support their breathing during their hospital stay. The study found that one year after hospital discharge, less than three in ten patients reported they felt fully recovered, largely unchanged from at five months. The most common ongoing symptoms were fatigue, muscle pain, physically slowing down, poor sleep and breathlessness. Participants felt their health-related quality of life remained substantially worse one year after hospital discharge, compared to pre-COVID. This suggests the physical and mental health impairments reported in the study are unlikely to be pre-existing conditions. Professor Chris Brightling said: “The PHOSP-COVID study is further evidence of the UK’s ability to combine expertise across both disease area and geography to rapidly gather data to help us understand the longer term implications of Long-COVID in hospitalised patients with persistent symptoms. Our findings show that people who were hospitalised and went on to develop Long-COVID are not getting substantially better a year after they were discharged from hospital. Many patients in our study had not fully recovered at five months and most of these reported little positive change in their health condition at one year. “When you consider that over half a million people in the UK have been admitted to hospital as a result of COVID-19, we are talking about a sizeable population at risk of persistent ill-health and reduced quality of life.” Read full story Source: National Institute for Health Research, 16 November 2021 -
News ArticleHealth experts have expressed fears over the impact tighter Covid restrictions in England could have on cancer patients as alarming new figures reveal that the number taking part in clinical trials plummeted by almost 60% during the pandemic. Almost 40,000 cancer patients in England were “robbed” of the chance to take part in life-saving trials during the first year of the coronavirus crisis, according to a report by the Institute of Cancer Research (ICR), which said COVID-19 had compounded longstanding issues of trial funding, regulation and access. Figures obtained from the National Institute for Health Research by the ICR show that the number of patients recruited on to clinical trials for cancer in England fell to 27,734 in 2020-21, down 59% from an average of 67,057 over the three years previously. The number of patients recruited for trials fell for almost every type of cancer analysed. Health experts said the relentless impact of Covid on the ability of doctors and scientists to run clinical trials was denying many thousands of cancer patients access to the latest treatment options and delaying the development of cutting-edge drugs. Read full story Source: The Guardian, 9 December 2021
