Search the hub
Showing results for tags 'Surgery - General'.
Found 485 results
-
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.
-
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?
-
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 ArticleData published in the New England Journal of Medicine demonstrates that use of CareFusion’s patient preoperative skin preparation ChloraPrep® (2% chlorhexidine gluconate and 70% isopropyl alcohol) reduced total surgical site infections (SSIs) by 41%, from 16.1% to 9.5%, compared to use of povidone-iodine solution, the most commonly used preoperative skin preparation. In this prospective, randomised and well-controlled outcomes trial designed to compare the efficacy of skin antiseptics in reducing the risk of SSIs, ChloraPrep proved superior in clean-contaminated abdominal, urologic, gynecologic and thoracic surgery. “For nearly a decade, healthcare professionals have relied on the proven efficacy of ChloraPrep,” said Stephen R. Lewis, MD, chief medical officer of CareFusion. “This study is an example of our ongoing commitment to providing clinicians with evidence-based data that clinically differentiates our products in order to help improve patient care and lower costs.”
-
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.
-
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.
-
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. -
News Article
Surgery delays: Man feels forgotten after six-year wait
Patient Safety Learning posted a news article in News
A County Tyrone man who has been waiting six years for a gall bladder operation has said he feels forgotten about by the health service. John Doherty, 55, said he could not understand why he was unable to get updates on his operation. BBC News NI can reveal almost 475,000 people are waiting for surgery or to see a consultant for the first time. The Royal College of Surgeons wants patients to be told how long they will have to wait for treatment. Mr Doherty said he felt anxious and depressed waiting for a telephone call from his local hospital and blamed the government for "letting him down". "I feel forgotten about, they don't even get in touch with you, not even a letter to say it could happen three months down the line... they say they'll phone back but never do," he added. "I feel neglected." Mark Taylor, a consultant surgeon, people who had been languishing for years on lists deserved to know when to expect their surgery so they could attempt to get in shape for it. He said about a one third of operations had to be cancelled daily as a result of people not being ready, either their blood pressure was too high, they were overweight or their diabetic control was not right. "Pre-habilitation schemes can help to get patients ready for their operation as much as possible, a more personalised pre operation plan is required," he said. Mr Taylor called on the government to have a proper conversation with the public about how hospitals might look in the future. "This is not about closure, this is about the redesign and re-profiling of hospitals to get maximum gain," he said. Read full story Source: BBC News, 15 February 2022 -
News ArticleAn amputee's wife having to "carry him to the toilet" after her husband was sent home from hospital without a care plan was just one of many findings in a report into vascular services at Betsi Cadwaladr University Health Board in north Wales. The critical report by the Royal College of Surgeons England makes five urgent recommendations "to address patient safety risks". Part one of the report, published last summer, made nine urgent recommendations and raised issues including too many patient transfers to the centralised hub, a lack of vascular beds and frequent delays in transfers. The final part of the report, published on 3 February, focussed on the clinical records of 44 patients dating from 2014 - five years before centralisation - to July 2021, two years after the Ysbyty Glan Clwyd hub opened. Assessors were "extremely concerned" about the case of a man where a decision was made to "amputate the foot rather than proceed to a below-the-knee amputation as the primary procedure". The report adds: "The review team also noted that the patient had been discharged without a care plan and that the patient's wife was having to 'carry him to the toilet'." It also highlights an "inappropriate" decision to offer a patient an "unnecessary and futile" amputation when "palliation and conservative therapy should have been considered instead". Referring to that case, the report added that the risk from "major amputation was extremely high". Read full story Source: BBC News, 3 February 2022
-
News ArticleA “very tense” behind-the-scenes row over how quickly hospitals in England can be expected to reduce the massive backlog of surgery has broken out between NHS bosses and ministers. The dispute has delayed publication of the government’s “elective recovery plan”, which Downing Street had indicated would be part of Boris Johnson’s “Operation Red Meat” political fightback this week. No 10, the Treasury and Department of Health and Social Care are pressing NHS England to ensure that hospitals do as many operations as they can, as quickly as possible, in order to tackle the backlog, which now stands at a record 6 million patients. They want to impose “stretching and demanding” targets on hospitals, sources with knowledge of the discussions said. However, NHS trust bosses say the ongoing impact of treating patients sick with Covid, due to the current Omicron surge, longstanding gaps in their workforce, exhaustion at the frontline and record levels of staff sickness, mean they need time to get back to doing as much surgery as they did before the pandemic. The Treasury is said to be frustrated with NHS England and privately believes it is “foot-dragging” over the targets. NHS bosses for their part fear the plan is being driven by “political expediency”, given the growing concern at the sheer number of people facing long delays for care. Read full story Source: The Guardian, 20 January 2022
-
News Article
Women 32% more likely to die after operation by male surgeon, study reveals
Patient Safety Learning posted a news article in News
Women who are operated on by a male surgeon are much more likely to die, experience complications and be readmitted to hospital than when a woman performs the procedure, research reveals. Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery, according to a study of 1.3 million patients. The findings have sparked a debate about the fact that surgery in the UK remains a hugely male-dominated area of medicine and claims that “implicit sex biases” among male surgeons may help explain why women are at such greater risk when they have an operation. “In our 1.3 million patient sample involving nearly 3,000 surgeons we found that female patients treated by male surgeons had 15% greater odds of worse outcomes than female patients treated by female surgeons,” said Dr Angela Jerath, an associate professor and clinical epidemiologist at the University of Toronto in Canada and a co-author of the findings. “This result has real-world medical consequences for female patients and manifests itself in more complications, readmissions to hospital and death for females compared with males. “We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences.” Read full story Source: The Guardian, 4 January 2022 -
News Article
Doctors report 13,000 cancelled operations in UK over two months
Patient Safety Learning posted a news article in News
UK hospitals have cancelled at least 13,000 operations over the last two months as they struggle to cope with record demand for NHS care and people sick with Covid-19. Figures collected by A&E doctors showed that 13,061 planned surgeries had to be called off during October and November because of shortages of beds and staff. However, the cancellations occurred at just 40 of the several hundred NHS hospitals across the four home nations, so those 13,061 are likely to be a major underestimate of the scale of the problem. Dr Adrian Boyle, a vice-president of the Royal College of Emergency Medicine (RCEM), which published the data, said the cancellations represented “a stark warning for the months ahead”. He also warned that A&E units across the NHS are “verging on crisis” because of their growing inability to provide timely care to the increasing numbers of patients seeking help. “Urgent and emergency care is verging on crisis and it is impacting and derailing elective care, meaning surgery for patients with serious conditions is delayed,” he added. Read full story Source: The Guardian, 7 December 2021 -
News Article
Man fitted with stoma after 'unnecessary' surgery
Patient Safety Learning posted a news article in News
A patient who suffered internal bleeding from surgery following an incorrect diagnosis, said he has "nightmares" about how he was treated. The public services ombudsman for Wales said it was "completely avoidable" and recommended health officials make a redress payment of £10,000. The man was initially referred to Cardiff's University Hospital of Wales with appendicitis. But, after a number of tests and scans, it was wrongly determined he had Crohn's disease, and colon surgery was recommended which led to a series of complications. The man, known as Mr D in the ombudsman's report, suffered internal bleeding from the initial surgery and required a stoma, despite being told the chances of that were "very, very slim". He also developed a hernia which required further surgery, and a mesh to be inserted. "I try and do things that wouldn't have been a problem for me years ago, and find I struggle," he said. "Sometimes I wake up still in pain from some of the scars. I sometimes have nightmares." The man, who has Asperger's syndrome, also said it was not taken into proper consideration during consultation. "I don't think there's a lot of things where people do take into account neurodiversity," he said. Ombudsman Nick Bennett called the case "regrettable" after investigating the man's complaint. "Physicians responsible for Mr D's care should have employed a watch and wait approach in which his condition would probably have settled without surgical treatment," he said. "Instead, Mr D, a vulnerable individual, faced completely avoidable trauma of unnecessary surgery and post-treatment complications - a trauma which saw him seek mental health support." Cardiff and Vale University Health Board said it accepted the findings. Read full story Source: BBC News, 7 December 2021 -
News Article
‘Outstanding’ rated trust given CQC warning notice after staff raised alarm
Patient Safety Learning posted a news article in News
An acute trust currently rated ‘outstanding’ has been served with a warning notice by the Care Quality Commission, after senior doctors’ safety concerns prompted an inspection. Inspectors visited University Hospitals Sussex Foundation Trust days after HSJ reported on a letter from consultants highlighting “an extremely unsafe situation” and calling for elective work to be moved away from one of the trust’s main hospitals. The inspection looked at surgical areas at the Royal Sussex County Hospital, in Brighton, and maternity services at four sites – the RSCH, St Richard’s in Chichester, Worthing Hospital and the Princess Royal Hospital in Haywards Heath. In a letter to all staff, seen by HSJ, chief executive Dame Marianne Griffiths said the trust was “striving to improve” but that “the last four months are like nothing I have ever seen before. Like others we are facing unprecedented daily challenges”. She said: “High patient numbers combined with continuing to work through the pandemic with the stringent infection prevention and control processes that entails make for a challenging work environment.” Chief nurse Maggie Davies said: “The safety of our patients is always our number one priority. Our services remain under unprecedented pressure and our staff are working hard to provide the highest standards of care to all our patients. Read full story (paywalled) Source: HSJ, 5 November 2021 -
News Article
Patients must be warned of breast implant risks, FDA says
Patient Safety Learning posted a news article in News
A decade after scientists identified a link between certain implants and cancer, the US Food and Drug Administration has ordered “black box” warnings and a new checklist of risks for patients to review. Federal regulators have placed so-called black box warnings on breast implant packaging and told manufacturers to sell the devices only to health providers who review the potential risks with patients before surgery. Both the warnings and a new checklist that advises patients of the risks and side effects state that breast implants have been linked to a cancer of the immune system and to a host of other chronic medical conditions, including autoimmune diseases, joint pain, mental confusion, muscle aches and chronic fatigue. Startlingly, the checklist identifies particular types of patients who are at higher risk for illness after breast implant surgery. The group includes breast cancer patients who have had, or plan to have, chemotherapy or radiation treatments. That represents a large percentage of women who until now were encouraged to have breast reconstruction with implants following their treatment. Reactions to the new requirements were mixed. While some doctors welcomed the new warning system, others worried that the potential risks and side effects would not be conveyed adequately by plastic surgeons who were eager to reassure patients the procedure is safe and that the new checklist would be handled in a dismissive manner. But Dr. Mark Clemens, a professor at M.D. Anderson Cancer Center in Houston who serves a liaison to the F.D.A. for the American Society of Plastic Surgeons Society, said the black box warning and checklist represented “a huge step forward for patient safety and implants.” Read full story Source: The New York Times, 27 October 2021 -
News Article
NHS and private hospitals told to improve after patient death
Patient Safety Learning posted a news article in News
The NHS and private hospitals need to improve how they work together after the death of an NHS patient treated privately during the pandemic, a watchdog has warned. An investigation by the Healthcare Safety Investigation Branch (HSIB) found some private hospitals took on more complex patients than they were used to, while problems with communication and confusion over responsibilities created safety risks. It has called on the Care Quality Commission to do more to inspect how the two sectors work together and how patients are transferred between hospitals safely. It launched an inquiry after the death of a patient, known as Rodney, aged 58, who was due to have keyhole surgery to remove part of his bowel due to cancer. His NHS operation was cancelled and rebooked at a nearby private hospital after cancer services were transferred to the independent hospital due to COVID-19. Rodney was asked to sign a consent form for open bowel surgery, rather than the less invasive keyhole procedure, due to guidance at the time around a "potentially increased risk of COVID-19 transmission with laparoscopic surgery", the HSIB said. The cancerous part of his bowel was removed but eight days later his condition he deteriorated rapidly and was transferred to the local hospital so he could receive intensive care - which was not available at the private hospital. When he arrived at the NHS hospital, a scan and more surgery showed a leak in his bowel which led to sepsis and organ failure. He died later that day. As a result of the case, the HSIB launched a wider investigation into NHS surgical services being carried out in independent hospitals. Read full story Source: The Independent, 28 October 2021 -
News Article
NHS plea for private help as covid forces cancer surgery cancellations
Patient Safety Learning posted a news article in News
NHS leaders are holding fresh talks with private healthcare groups to try to secure surgery for urgent cancer patients in London, as the covid-19 second wave causes hospitals in the capital to make widespread cancellations, HSJ understands. In recent weeks, pivotal independent sector providers have declined to do the procedures for the payments on offer. In the spring covid peak, the NHS block-booked private capacity in London, but now only small, spot contracts are in place for this work. Under the previous deal, rules meant low-priority private patients could not be treated ahead of NHS patients who needed surgery urgently. But now providers can prioritise their private patients as they see fit. HSJ understands NHS England, under pressure from the Treasury, was not willing to pay the prices asked by the three private providers. As London NHS hospitals continue to fill with covid patients, particularly in critical care, they are able to do few cancer procedures beyond the most urgent category, P1, and are suspending many procedures in the lower categories, including P2, sources said. P2 is defined as patients who need treatment within four weeks. One senior clinical manager in the city told HSJ on Monday: “Cancellations [are] rife. We have stopped almost all operating in our elective hub apart from P1 [patients assessed as needing surgery within three days]. “The independent sector has not opened up capacity and lifestyle operations [are] still planned [in private hospitals].” Read full story (paywalled) Source: HSJ, 5 January 2021 -
News ArticleDeath rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found. A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019. Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%. But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6% The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013. Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review. Read full story (paywalled) Source: HSJ, 20 November 2020 .
-
News ArticlePatients who receive good perioperative care can have fewer complications after surgery, shorter hospital stays, and quicker recovery times, shows a large review of research. The Centre for Perioperative Care, a partnership between the Royal College of Anaesthetists, other medical and nursing royal colleges, and NHS England, reviewed 27 382 articles published between 2000 and 2020 to understand the evidence about perioperative care, eventually focusing on 348 suitable studies. An estimated 10 million or so people have surgery in the NHS in the UK each year, with elective surgery costing £16bn a year. A perioperative approach can increase how prepared and empowered people feel before and after surgery. This can reduce complications and the amount of time that people stay in hospital after surgery, meaning that people feel better sooner and are able to resume their day-to-day life. Read full story (paywalled) Source: BMJ, 17 September 2020
-
News Article
NHS increases surgery sessions to tackle hospital waiting lists
Patient Safety Learning posted a news article in News
Hospitals are putting on extra surgery sessions in the evenings and at weekends to tackle the NHS’s spiralling waiting list and cut waiting times for patients. Health trusts in England are taking the unusual step after a rise in people waiting for cancer, heart and other treatment – and especially those forced to wait more than a year – because of the pandemic. Doctors, surgeons, health charities and hospital bosses are concerned that unusually long delays in accessing care could lead to patients’ conditions worsening or becoming inoperable. NHS Providers, which represents hospitals, fears sorting out the backlog could take up to five years. Four trusts spanning 10 acute and specialist hospitals in west and north-west London have joined forces to treat each other’s patients in a move to tackle the huge numbers seeking care. Figures collated by the trusts and shared with the Guardian show how dramatically waiting lists have increased across that area, as they have across England as a whole, as a result of the widespread suspension of normal NHS care over the last year. Read full story Source: The Guardian, 23 April 2021 -
News Article
Trusts team up for weekend surgery drive to cut paediatric waiting times
Patient Safety Learning posted a news article in News
Three acute trusts have teamed up to carry out surgical procedures on hundreds of children over several weekends as part of plans to tackle waiting lists in the region. Trusts across the Bath and North East Somerset, Swindon and Wiltshire Integrated Care System are pooling resources to tackle long waits in paediatric oral and ear, nose and throat services. The initiative began on the April bank holiday weekend. Thirty-eight of the longest waiters from Royal United Hospitals Bath Foundation Trust, who had been waiting up to 74 weeks for oral surgery, were treated by Salisbury FT. The other trust involved in the plans is Great Western Hospitals FT. More than 400 children are expected to be treated over a series of joint surgery weekends. The next, which will also focus on both oral and ENT surgery, will take place over the early May bank holiday. RUH’s chief executive Cara Charles-Barks told HSJ the joint surgery plans will have a “huge impact” on the region’s elective waiting lists. Read full story (paywalled) Source: HSJ, 21 April 2021 -
News ArticlePatients could be waiting as much as two years for vital operations by the time of the next election due to a “truly frightening” backlog of care caused by the pandemic, the NHS’s former boss has said. Lengthening delays in getting treatment in England are will become a major political problem for Boris Johnson and pose a risk to patients’ health, Sir David Nicholson told the Guardian. “The backlog is truly frightening. We can very easily get to the next election with people waiting over two years. It’s easy to do that,” said Nicholson, citing an explosion in the number of people waiting at least a year since the start of the COVID-19 crisis. “The whole issue of access [to care] is a greater threat to the NHS than privatisation because poor access undermines confidence amongst those people who fund the service – taxpayers,” he added. The widespread suspension of normal NHS diagnostic tests and surgery during the pandemic as hospitals prioritised Covid care has left the service in England with a record 4.59 million people waiting for hospital treatment. That number is set to rise to what the NHS Confederation believes could be as much as 6.9m cases by the end of the year as people on a “hidden waiting list” – who put off seeking help after discovering symptoms of illness – finally visit a GP. According to the most recent figures, the number of people who have been waiting for at least a year has rocketed from 1,613 before the pandemic struck to 304,044. Under the NHS Constitution, 92% of people waiting are meant to be treated within 18 weeks. However, a third of the 4.59 million people have already waited longer than that. Read full story Source: The Guardian, 2 April 2021
-
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 ArticleMore than a dozen NHS patients have stopped breathing and 40 others suffered serious effects after having powerful anaesthetic drugs mistakenly “flushed” into their systems by unsuspecting NHS staff. In one case a man has been left suffering nightmares and flashbacks after he stopped breathing on a ward when a powerful muscle relaxant used during an earlier procedure paralysed him but left him fully conscious. He only survived because a doctor was on the ward and started mechanically breathing for him. An investigation by the safety watchdog, the Healthcare Safety Investigation Branch (HSIB), found there had been 58 similar incidents in England during a three-year period. The mistakes happen when residual amounts of drugs are left in intravenous lines and cannulas and not “flushed” out after the surgery. When the IV lines are used later by other staff the residual drugs can have a debilitating effect on patients. In a new report HSIB said flushing intravenous lines to remove powerful drugs was a “safety-critical” task but that the process for checking this had been done was not being properly carried out, posing a life-threatening risk to patients. It said the use of a checklist by anaesthetic staff can be overlooked when doctors are busy with other tasks and they fail to engage with the process. Read full story Source: The Independent, 4 March 2021
