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Content ArticleSickle cell disease is the name for a group of inherited red blood cell disorders that affect haemoglobin, which is a protein in red blood cells that carries oxygen through a person’s body. It mainly affects people from African or Caribbean backgrounds, though it can affect anyone. It affects approximately 15,000 people in the UK. In November 2021, the All-Party Parliamentary Group for Sickle Cell and Thalassaemia published a report detailing the issues that people with sickle cell disease experience in relation to their care. The report made 31 recommendations to organisations across the healthcare system to help address these issues. HSIB launched two investigations (see also: Management of sickle cell crisis) to find out what additional learning or knowledge could be added in this area and to provide further insights into the practical challenges that patients with sickle cell disease may face when receiving NHS care. This investigation set out to review the care of patients with sickle cell disease who need to have an invasive procedure. Invasive procedures involve accessing the inside of a patient’s body, either through an incision (cut) or one of the body’s orifices. Specifically, the investigation focused on: how haematology teams – the specialists who treat people with blood disorders – are involved and informed when a patient with sickle cell disease is treated in another area of healthcare how patients with sickle cell disease are prepared for invasive procedures how and where clinical information relevant to the patient is shared.
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Content Article
PIT stop (prosthesis/implant timeout) checklist
Nigel Roberts posted an article in Surgery
The PIT stop (prosthesis/implant timeout) checklist is Birmingham Women's and Children's NHS Trust's visual and aid memoir. It was launched to limit 'human error' and thus preventing never events (wrong implant/prosthesis). The four steps cover the intra-operative stages when implants are required. It works by recording what is requested on a small, hand held white board, and works in harness with the NatSSIPs 8, specifically step 5 of the infographic that has been previously developed. -
Content ArticleTony Clarke suffered from a chronic inflammatory skin disease, hidradenitis suppurativa. In September 2020, Tony underwent surgery to remove infected tissue on one side of his body. When he entered the operating theatre, Tony’s surgical team first covered part of his body with an alcohol-based solution, to keep the area clean. Then, when the operation began, the surgeons began cutting off the infected tissue using a diathermy pen, a device that targets electrically-induced heat to stop wounds from bleeding. However, shortly into the surgery, disaster struck: heat from the surgical pen had ignited the alcohol on Tony’s body. “But because alcohol burns so hot, no fire was seen,” says Tony, recalling an explanation he later received from the hospital. “The surgeons were concentrating on the right side of my body. The left side was left burning for about 20 minutes.” For the next four months, Tony travelled back to the hospital every three days, to get his injuries checked and bandages changed. During that time, Tony describes himself as ‘totally disabled.’ In September this year, Tony, as a patient ambassador for prevention of surgical fires, spoke at a conference held in York by the Association for Perioperative Practice (AFPP). There, perioperative practitioners from across the country gathered to listen to Tony’s experience. “I was speaking to lots and lots of different professionals in the medical service and they'd never heard of it [being set on fire during surgery]. It was a rarity for them,” Tony says. Tony’s now working with different health agencies, with the aim of stopping preventable surgical burns entirely.
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Content ArticleThis paper from Roberts et al. examines the application of the Surgical Safety Checklist (SSC) within NHS hospital operating theatres England. The aim of the study, through a combination of open-ended questions, was to solicit specific information including views and opinions from operating theatre experts to establish from how the World Health Organisations (WHO) SSC is being applied, and therefore and why intraoperative ‘Never Events’ continue to occur more than a decade after the SSC was introduced. Participants were from the seven regions identified by NHS England. The intention of this paper is not to establish definitively whether the quantitatively identified themes; including a lack of training and engagement with human factors explains the increased presence of intraoperative ‘Never Events’. However, these themes, when subjected to methodological triangulation with the current literature, do appear consistent, and therefore provide an exploratory approach to inform research intended to improve safety in the operating theatre by informing policy and its application to safe practice ultimately towards quality improvements.
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News Article
Ayrshire MSP Katy Clark wants ban on surgical mesh use in hernia ops
Patient Safety Learning posted a news article in News
AN Ayrshire MSP has called for an end to surgical mesh being implanted in hernia patients in Scotland. A Freedom of Information request by Labour's Katy Clark has revealed that one in 12 of all hernia patients in NHS Ayrshire and Arran who have been implanted with surgical mesh since 2015 have been readmitted to hospital due to complications. And the West of Scotland MSP has backed a petition by constituents calling for the suspension of the use of surgical mesh until an independent review has been carried out. It follows the recent public health scandal over the pain and suffering endured by many women across Scotland implanted with transvaginal mesh. It took years of tireless campaigning by affected women before the Scottish Government took action, last year creating a mesh removal reimbursement scheme. Read full story Source: Irvine Times, 9 June 2023 -
EventuntilThe aim of this webinar is to share, engage and discuss with clinicians, patient safety managers, patients and leaders the latest standards. There will be 2 sessions: 17.30: Session 1 – NatSSIPs 2: what it is and why it matters Welcome and introduction The CPOC perspective The Patient Safety Learning perspective Photo review of why NatSIPPs matters The patient perspective What is new in NatSIPPs 2? Resources to support Implementation: Checklists, infographics Q&A 18.30: Session 2 – NatSSIPs 2: implementation, practical insights and tips Our NatSIPPs 2 Workshop and how to consider a NatSSIPs gap analysis Team training for NatSIPPs 2 Q&A Register
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Content Article
Digital delivery of information is the new normal and it’s important that healthcare providers adapt quickly. Informed consent in the UK needs to be backed up by the BRAN principle: Benefits, Risks and Alternatives including the option of doing Nothing. In this blog, Julie Smith, Content Director at EIDO Healthcare, will use the same principles to consider the use of digital solutions for patient information. This blog is not exhaustive but will hopefully provide some food for thought around the patient safety considerations relating to digital information. -
Content ArticleIn this blog, specialist medical negligence solicitor Maria Panteli discusses the upcoming investigation and possible inquests into deaths relating to jailed breast surgeon Ian Paterson. She looks at what families of those affected by his treatment can expect and covers topics including:What happens at a Pre-Inquest Review?Who takes part in an inquest?How can the medical negligence solicitors help?
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News ArticlePolice are investigating about 40 hospital deaths over allegations of medical negligence made by two consultant surgeons who lost their jobs after blowing the whistle about patient safety. The allegedly botched operations took place at Royal Sussex County hospital (RSCH) in Brighton, part of University hospital Sussex NHS trust, when it was run by a management team hailed by Jeremy Hunt as the best in the NHS. Last week, detectives from Sussex police wrote to the trust’s chief executive, George Findlay, confirming they had launched a formal investigation into “a number of deaths” at the RSCH. They were investigating allegations of “criminal culpability through medical negligence” made by “two separate clinical consultants” at the trust, the letter said. It is understood about 40 deaths occurred between 2015 and 2020 after alleged errors in general surgery and neurosurgery departments. Both whistleblowers alleged the trust failed to properly investigate the deaths and learn from the mistakes made. Read full story Source: The Guardian, 9 June 2023
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EventuntilThis enlightening session during Wounds Week dives into the world of surgical infection prevention. The session will explore a range of assessment and improvement tools provided by the World Health Organization (WHO) that have a significant impact on infection prevention and patient outcomes. Claire Kilpatrick, Consultant, Global Health - KSHealthcare (S3Global), will guide you through an overview of various WHO tools that have been developed to guide healthcare practitioners in infection prevention practices. By examining these tools and understanding their significance, you will gain practical knowledge on how to implement effective measures that minimise the risk of surgical infections and enhance patient outcomes. Register
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News Article
People paying for operations up by third since Covid pandemic
Patient Safety Learning posted a news article in News
The number of people paying privately for operations and treatments in the UK has risen by more than a third since the pandemic started, the latest figures from the Private Healthcare Information Network (PHIN) show. Last year 272,000 used their own money to pay for treatments, such as knee or eye surgery - up from 199,000 in 2019. The NHS backlog has been blamed for the trend, with some of the treatments costing more than £15,000. But there does appear to have been a shift away from private insurance driven by the cost of living crisis. The numbers treated through that route were just below 550,000 - more than 30,000 fewer than three years ago. Health providers are reporting patients desperate for treatment because of NHS waits are increasingly turning to the private market. Read full story Source: BBC News, 24 May 2023 -
Content ArticleRemote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. It concluded that remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.
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News Article
Use private sector more for NHS patients, says Labour
Patient Safety Learning posted a news article in News
The government in England should increase its use of the private sector to tackle the NHS backlog, Labour says. It said as many as 300,000 patients have missed out on treatment since it called for greater use of private clinics in January 2022. And the party said it was unjust that the lack of action meant only those who could afford to pay for treatment themselves were being seen on time. The government said it was delivering by cutting long waits. However, data published by NHS England last week showed key targets to tackle the backlogs in cancer care and routine treatment had been missed. Overall, there are now a record 7.3 million people on a hospital waiting list, which is nearly three million higher than it was before the pandemic started. Read full story Source: BBC News, 19 May 2023 -
Content Article
More than just physical blog
Patient-Safety-Learning posted an article in Patient stories
This series of blog posts is written by a patient who experienced life-changing complications after surgery went wrong. In her posts, they explore the psychological needs of patients following healthcare harm, which are often overlooked during physical rehabilitation. "I believe that the emotional support given to the patient during those first few weeks can make a significant difference to their long term quality of life. That’s why I decided to write this blog, to give constructive feedback to help medical professionals learn from my experiences." -
Content ArticleShould new draft legislation around the use of mesh in women regarding incontinence or prolapse and a new guidance on a national registry meaning every woman choosing mesh in the future must be logged on a database be extended? Haydn Wheeler argues that a broader database is in need.
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News Article
UK surgical workforce census 2023 opens
Patient Safety Learning posted a news article in News
The Royal College of Surgeons of England is conducting a census to gain a better understanding of the surgical workforce. Through the census, they will be able to gather comprehensive information on the composition of the surgical workforce, its demographics and working practices. Most importantly, it allows members of the surgical workforce to share the most pressing challenges they are facing. It aims to: Better appreciate the needs, challenges, and working practices of the surgical workforce. More effectively represent and advocate for the workforce. Offer better support Create a better working environment. Enhance sustainability, including measures to improve retention, recruitment and work-life balance. Improve future planning. Take part in the survey -
News Article
Patient scarred for life after botched operation left him with severe burns
Patient Safety Learning posted a news article in News
A patient who was left scarred for life when a botched operation left him with horrific burns has received a payout after suing the NHS. Paul Hickman, 44, underwent routine surgery to improve circulation in his legs when medics at Russell Hall Hospital in Dudley, West Midlands, wrongly used a heated mattress. He ended up with significant burns on his buttocks after an alcohol-based solution came into contact with the back of both thighs and his backside. Mr Hickman, of Walsall, West Midlands, said: “I hoped that the surgery would go well and would improve my health. “However, all I remember afterwards was being in severe pain. “To be told I had suffered burns was a complete shock and at first was difficult to try and take in. I couldn’t understand how that had happened". An NHS investigation found the use of heated mattresses was stopped in the type of procedure Mr Hickman underwent after another patient was burnt in 2016. The report found the use of alcohol-based solution during Mr Hickman’s preparation for surgery and the “inappropriate use” of a heated mattress in surgery led to his burns. Read full story Source: The Independent, 4 May 2023 -
News Article
Global hernia repair devices market is estimated to grow at a CAGR
Patient Safety Learning posted a news article in News
The rising prevalence of hernia disorders, technological advancements in hernia repair devices, growing adoption of mesh in hernia repair surgeries, rising geriatric population and high adoption of hernia repair surgical procedures are some of the key factors driving the global hernia repair devices market, reports Yahoo News. Leading players operating in the global hernia repair devices market are adopting both organic and inorganic growth strategies such as collaborations, acquisitions, and new product launches to garner a higher market share. For instance: In February 2023, TELA Bio, Inc announced the launch of two additional configurations of its OviTex LPR device. The new configurations are 15 x 20 cm and 15 x 25 cm ellipses designed for ventral and incisional hernias. In December 2022, Deep Blue Medical Advances announced that they have received an additional 510(k) clearance from the US FDA for its T-Line Hernia Mesh for the subway technique in open hernia surgery. However, in a recent Tweet, campaign group Sling the Mesh voice their concerns: -
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 ArticleThe Operating Room Black Box (OR Black Box) is a system that collects, stores and analyses a large amount of data from the operating room beyond just surgical video, such as video and audio of the operating room and patient physiology data. In this episode of the Behind the Knife podcast, Dr. Teodor Grantcharov, one of the creators of the OR Black Box, talks about how the technology can be used to enhance surgical training. Using the system for feedback through self-directed review, coaching and integrated AI analysis has changed the way we can learn and teach in surgery, and may have implications for the future of evaluation and assessing credentials.
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Content ArticleThe objective of this study from Sharma et al. was to evaluate the accuracy of a new elective surgery clinical decision support system, the ‘Patient Tacking List’ (PTL) tool (C2-Ai(c)) through receiver operating characteristic (ROC) analysis. They found that the PTL tool was successfully integrated into existing data infrastructures, allowing real-time clinical decision support and a low barrier to implementation. ROC analysis demonstrated a high level of accuracy to predict the risk of mortality and complications after elective surgery. As such, it may be a valuable adjunct in prioritising patients on surgical waiting lists. Health systems, such as the NHS in England, must look at innovative methods to prioritise patients awaiting surgery in order to best use limited resources. Clinical decision support tools, such as the PTL tool, can improve prioritisation and thus positively impact clinical care and patient outcomes.
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Content ArticleAccording to the World Health Organization, humanity faces its greatest ever threat: the climate and ecological crisis. Healthcare services globally have a large carbon footprint, accounting for 4-5% of total carbon emissions. Surgery is particularly carbon intensive, with a typical single operation estimated to generate between 150-170kgCO2e, equivalent to driving 450 miles in an average petrol car. The UK and Ireland surgical colleges have recognised that it is imperative for us to act collectively and urgently to address this issue. The Royal College of Surgeons of Edinburgh have collated a compendium of peer-reviewed evidence, guidelines and policies that inform the interventions included in the Intercollegiate Green Theatre Checklist. This compendium should support members of the surgical team to introduce changes in their own operating departments. The recommendations apply the principles of sustainable quality improvement in healthcare, which aim to achieve the “triple bottom line” of environmental, social and economic impacts.
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Content ArticleStandard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Morgan et al. evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. They found that SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change.
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Content ArticleThe African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality rate twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. This aim of this study in The British Journal of Anaesthesia was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was developed using data from 8799 patients in 168 African hospitals. It includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The authors concluded that the ASOS Surgical Risk Calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.
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News Article
Junior doctors’ April strike led to 195,000 NHS hospital cancellations
Patient Safety Learning posted a news article in News
Almost 200,000 hospital appointments and procedures in England were cancelled during last week’s junior doctors’ strikes, it has been revealed. There were 20,000 more appointments cancelled in the strikes that ran between 11 and 15 April than in the shorter strike in March, NHS England figures show. A total of 27,361 staff were not at work during the peak of the strikes, though the true figure could be higher as some workforce data was incomplete. The NHS’s national medical director, Prof Sir Stephen Powis, said the figures showed the “colossal impact of industrial action on planned care in the NHS”, with nearly half a million appointments rescheduled over the last five months. He said every postponed appointment had “an impact on the lives of individuals and their families and creates further pressure on services and on a tired workforce – and this is likely to be an underestimate of the impact as some areas provisionally avoided scheduling appointments for these strike days”. Read full story Source: The Guardian, 17 April 2023
