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Content ArticleIn this report, the Public Accounts Committee, which examines the value for money of UK Government projects, programmes and service delivery, looks in detail at the implementation of NHS England’s three-year recovery programme for tackling the Covid-19 backlog of elective care.
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Content ArticleIn this blog, the Healthcare Safety Investigation Branch (HSIB) reflects on the recent publication of the new National Safety Standards for Invasive Procedures (NatSSIPs 2) by the Centre for Perioperative Care. It outlines how these standards can help NHS organisations provide safer care and reduce the number of patient safety incidents, including a comment on this from Deinniol Owens, Associate Director of National Investigations at HSIB.
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Content ArticleThe purpose of this assessment is to ensure that all Theatre Practitioners are fully compliant with current Trust Policy with regard to swabs, instruments, sharps and disposables items. All Theatre staff must be assessed and deemed competent.
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Content ArticleThe original National Safety Standards for Invasive Procedures (NatSSIPs) were published in 2015. Understanding of how to deliver safe care in a complex and pressurised system is evolving. These revised standards (NatSSIPs2) are intended to share the learning and best practice to support multidisciplinary teams and organisations to deliver safer care. The Centre for Perioperative Care shares their slideset on the revised standards.
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Content ArticleIn this video, William Pileggi, a registered nurse anaesthetist, discusses the implementation of the Golden Eagle Project at the VA Pittsburgh Healthcare System to improve outcomes for veterans who may be prone to experiencing post-operative emergent delirium. Through assessments to prescreen for PTSD, staff training and using alternative drug therapies, his hospital has had zero injury events related to emergent delirium since 2018. With minor modifications, the program is replicable at civilian hospitals.
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Content ArticleThe Centre for Perioperative Care (CPOC) has published new safety standards (NatSSIPs2) to enable all hospitals in the UK to improve patient safety by applying a consistent and proportionate set of safety checks for all invasive procedures. Listen to the podcast from the Royal College of Anaesthetists on the new standards.
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News Article
Consultant refused to carry out urgent surgery at trust facing criticism from CQC
Patient Safety Learning posted a news article in News
A consultant surgeon refused to attend hospital to carry out urgent surgery at a trust which later had upper gastrointestinal surgery suspended after an unannounced Care Quality Commission visit. The CQC report into upper GI surgery at the Royal Sussex County Hospital in Brighton – based on an inspection in August – said incident reports revealed occasions when upper GI surgeons could not be contacted or refused to come into hospital to treat patients. In one case, a consultant would not come in to carry out urgent surgery, it added. Low numbers of surgeons meant the on-call rota for upper GI was shared with the lower GI surgeons. This meant an upper GI specialist was not always available immediately, despite guidance from a professional body that 24/7 subspecialty cover was needed at centres which carry out major resectional surgery. This surgery was suspended at the RSCH after the August inspection and has yet to be reinstated. Mortality at both 30 and 90 days for patients with oesophago-gastric cancer was twice the national average between 2017 and 2020 – though the trust was not an outlier – and there was an increasing number of emergency readmissions for patients who had undergone upper GI surgery, the report said. Read full story (paywalled) Source: HSJ, 1 December 2022 -
News Article
Urgent surgery ‘may be postponed’ by nurses’ strikes, say NHS bosses
Patient Safety Learning posted a news article in News
Hospitals may not be able to provide key elements of healthcare such as urgent surgery, chemotherapy and kidney dialysis during the forthcoming strikes by nurses, NHS bosses have said. Trusts may also have to stop discharging patients, postpone urgent diagnostic tests and temporarily withdraw services to people undergoing a mental health crisis. Executives have been warned that industrial action by nurses in their pay dispute with the government could mean that a range of important, and in some cases time-critical, services to seriously ill patients may have to be scaled back or suspended altogether. NHS England bosses have raised that possibility in a letter sent on Monday to hospitals and other care providers ahead of crunch talks with the Royal College of Nursing later this week. At that meeting they will try to agree what areas of care will be hit on Thursday 15 and Tuesday 20 December, and which will continue as normal because they are covered by “derogations” – agreed exemptions to the action. The letter sets out a list of 12 areas of care and some non-clinical activity in hospitals, such as food supply, which could be affected if agreement is not reached with the nurses’ union. Eight of those involve direct patient care, three involve support services in NHS trusts and the other involves “system leadership and management to oversee safe care” on strike days. NHS England’s letter sets out 10 other types of vital care, mainly involving life or death scenarios, headed “derogations not needed”, which they hope to agree with the RCN to go ahead as normal. These include A&E care, services in intensive care units and emergency operating theatres as well as maternity services, including the delivery of babies, psychiatric intensive care, time-critical organ transplants and palliative and end of life care. Meanwhile, the chief executive of NHS England has insisted patients will not have procedures cancelled at the last minute due to the nurses’ strikes, but warned some care would have to be delayed. Read full story Source: The Guardian, 28 November 2022 -
News Article
The puzzle of UK’s half a million missing workers
Patient Safety Learning posted a news article in News
For the first time, more than 2.5 million people in the UK are out of work because of a long-term health problem. The number has jumped by half a million since the start of the pandemic - but, BBC News analysis reveals, the impact is spread unevenly across the country, with some regions and types of job far more affected. For Mary Starling, there are good days and bad days. The 61-year-old is on strong painkillers, for arthritis. She needs a knee replacement - but that could mean another 18 months on an NHS waiting list. Mary is keen to return to that work - but needs her operation first. "I feel despair - but I'm resigned to it," she says. "I understand it isn't possible to magic up something, though it's wearing not being able to plan my life." The UK is in its fourth year of sharply rising chronic illness. The highest rates are among 50- to 64-year-olds, but there have also been significant increases in some younger groups. Although the link is not conclusive, the Bank of England has said record NHS waiting lists are likely to be playing a "significant role". Some of the largest increases are in people reporting mobility difficulties, such as leg and back problems, or heart and blood-pressure problems. More younger people, in particular, say they are not in work because of different forms of mental illness. But the largest increase in long-term sickness is in the catch-all "other health problems" category, likely to include some of those with "long Covid" symptoms. Read full story Source: BBC News, 23 November 2022 -
News Article
NHS patients in England face longest waits on record for surgery and cancer care
Patient Safety Learning posted a news article in News
Far fewer people are having surgery or cancer treatment because COVID-19 has disrupted NHS services so dramatically, and those who do are facing the longest waits on record. NHS figures reveal huge falls in the number of patients who have been going into hospital for a range of vital care in England since the pandemic began in March, prompting fears that their health will have worsened because diseases and conditions went untreated. Patients have been unable to access a wide range of normal care since non-COVID-19 services were suspended in hospitals in March so the NHS could focus on treating the disease. Many patients were also afraid to go into hospital in case they became infected, which contributed to a fall in treatment volumes. Tim Gardner, a senior policy fellow at the Health Foundation thinktank, said: “The dramatic falls in people visiting A&E, urgent referrals for suspected cancer and routine hospital procedures during lockdown are all growing evidence that more people are going without the care they need for serious health conditions." “Early diagnosis and prompt treatment of cancer is crucial to saving lives, and delays in referrals and treatment during the pandemic are likely to mean more people are diagnosed later when their illness is further advanced and harder to treat.” Read full story Source: Guardian, 9 July 2020 -
News Article
Hospitals 'want to cut PPE requirements to speed surgery return'
Patient Safety Learning posted a news article in News
Some hospitals have sought to water down PPE requirements in order to “accelerate” the return of planned surgery, senior doctors have said, as they issued new guidance aiming to inform the decision. The Royal College of Anaesthetists, along with partners including the Faculty of Intensive Care Medicine, released a document to members to tackle “marked uncertainty amongst operating theatre team members as to which infection prevention and control precautions should be taken when treating screened patients in planned surgical pathways”. The document provides recommendations for teams on how to adjust PPE usage, which the college said was “supportive and consistent” with current Public Health England guidance. Professor William Harrop-Griffiths, consultant anaesthetist and council member of the Royal College of Anaesthetists, told HSJ some hospitals wanted to decrease the amount of PPE used as it might enable them to “accelerate and increase the workload”. However, the college has argued that there is currently “no clear guidance on when you might consider making that change”. “You have to balance that to the risk to the staff,” Professor Harrop-Griffiths stressed. Read full story (paywalled) Source: HSJ, 29 June 2020 -
News Article
Hospital chiefs keen to restart operations as covid peak passes
Patient Safety Learning posted a news article in News
Several acute trust chief executives have told HSJ they are keen to resume more planned operations, as the peak of new coronavirus cases has passed and many hospital beds remain empty. Some trust leaders said they believed routine elective surgery could be restarted as early as next week. There is also tension between NHS hospitals — some of which are keen to resume their own planned care, especially the more urgent operations — and a desire to use private hospitals, which have been booked out by NHS England. The government said yesterday the number of people in hospitals with COVID-19 has fallen by 10% over the last week. Around 42% of acute beds are now unoccupied, according to figures seen by HSJ. The peak of new infection cases in hospitals was at about 3,000 on 1 April — the number is now about half that figure. However, there will be fears nationally about the NHS seeking to return to normal and being caught out by ongoing COVID-19 pressures, or by a second peak of infections. Read full story Source: HSJ, 24 April 2020 -
News ArticleNHS hospitals have been told to cancel operations in an effort to free up 30,000 beds to create space for an expected surge in coronavirus patients. In a letter to NHS bosses today, NHS England said hospitals should look to cancel all non-urgent surgeries for at least three months starting from 15 April. Hospitals were given discretion to begin winding down activity immediately to help train staff and begin work setting up makeshift intensive care wards. Any cancer operations and patients needing emergency treatment will not be affected. The letter from NHS England Chief Executive Simon Stevens said: “The operational aim is to expand critical care capacity to the maximum; free up 30,000 (or more) of the English NHS’s 100,000 general and acute beds." In the meantime hospitals were told to do as much elective surgery, such as hip operations and knee replacements, as possible and to use private sector hospitals which it said could free up 12 to 15,000 beds across England. Sir Simon also said patients who did not need to be in hospital should be discharged as quickly as possible adding: “Community health providers must take immediate full responsibility for urgent discharge of all eligible patients identified by acute providers on a discharge list. For those needing social care, emergency legislation before Parliament this week will ensure that eligibility assessments do not delay discharge. Read full story Source: The Independent, 17 March 2020
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News Article
Nurses to carry out surgery under NHS plans to slash waiting times
Patient Safety Learning posted a news article in News
Nurses will be trained to perform surgery under new NHS measures to cut waiting times. Nursing staff will be urged to undertake a two year course to become “surgical care practitioners” as part of the drive to slash waiting times but critics have warned it will worsen the nursing shortage. Nurses who qualify will be tasked with removing hernias, benign cysts and some skin cancers, according to the Daily Mail. They will also assist during major surgeries such as heart bypasses and hip and knee replacements. The re-trained nurses will be tasked with closing up incisions after operations. The proposals are contained within the NHS’s People Plan, due to be unveiled next month. Lib Dem health spokesman Munira Wilson said: "This is a sticking plaster solution to very serious staffing crisis across our NHS workforce.'" However the proposals were backed by Professor Michael Griffin, president of the Royal College of Surgeons of Edinburgh. He said: "We are totally supportive of this. We have very little anxiety about this.” Read full story Source: 24 February 2020 -
News ArticleDozens of women who thought they were having a "complete mesh removal" have discovered material has been left behind, the BBC's Victoria Derbyshire programme has been told. Some women have been left unable to walk, work or have sex after having the initial vaginal-mesh implants. Specialist surgeons say in some cases total or partial mesh removal can be beneficial. But some women said their symptoms had become worse. One was left suicidal. Vaginal-mesh implants remain available on the NHS in England but only when certain conditions are met. In Scotland, the use of mesh was halted in 2018. One paitent said her surgeon had promised her a "full mesh removal", but she has now been told more than 10cm (4in) could have been left behind. She had the mesh implanted several years ago to treat urinary incontinence and said she had woken after the surgery with "chronic pain in my legs, my groin and my hips". It is believed she suffered nerve damage. A year later – after being told by one expert a mesh removal would be unlikely to resolve her pain – she found a surgeon who told her the implant could be completely removed. She had two operations, each taking her half a year to recover from, and was told there had been a full removal. But "within a few months" the pain began to return and her health deteriorated and she found out that only 5–8cm had been removed. "My whole world turned upside down," she said, breaking into tears. She has since been told by a separate specialist her form of mesh was one of the most difficult to remove and could cause significant nerve damage if not removed properly. She said she had never been told this by her surgeon. The number of women affected is unknown but the Victoria Derbyshire programme understands there are at least dozens of such cases. The Royal College of Obstetricians and Gynaecologists said in a statement that it took "each and every complication caused by mesh very seriously". It said: "Women must be informed of all options available and the benefits and risks of each so they can make the best decision about their care." Read full story Source: BBC News, 6 February 2020
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Content ArticleOperations can have cognitive side-effects, particularly in the over-65s but also in the very young. How can science minimise the danger?
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Content ArticleMartin Bromiley is a commercial airline training Captain and founder of The Clinical Human Factors Group. This episode of the Leadership Enigma podcast is deeply personal, inspirational and thought provoking. Martin describes how he turned the loss of his wife after a surgical procedure into a mission to understand and help others embrace the need for non-technical behaviours especially during critical times. He chats about the aviation and healthcare industry in relation to themes such as deference to hierarchy, the checklist manifesto, confident humility and creating an environment where your team and organisation embrace the challenge to 'double their error rate.' Behaviours are the bedrock for living your values and creating a culture that is positive and sustainable.
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Content ArticleEffective communication is critical for patient safety. One potential threat to communication in the operating room is incivility. Although examined in other industries, little has been done to examine how incivility impacts the ability to deliver safe care in a crisis. Katz et al. sought to determine how incivility influenced anaesthesiology resident performance during a standardised simulation scenario of occult haemorrhage.
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Content Article
CORESS reports
Patient Safety Learning posted an article in Surgery
CORESS is an independent charity, which aims to promote safety in surgical practice in the NHS and the private sector. CORESS receives confidential incident reports from surgeons and theatre staff. These reports are analysed by the Advisory Board, who make comments and extract lessons to be learned. Aiming to educate, and avoid blame, CORESS calls on surgeons to recognise a near miss or adverse event, react by taking action to stop it happening and then report the incident to CORESS so that the lessons can be published. Every month CORESS highlight's one of the cases reported for you to consider the issues raised and read the experts comments. -
Content ArticleMr David O’Regan, Director of the Faculty of Surgical Trainers, offers this new video series exploring topics that are pertinent to surgical training and trainers. He looks beyond the field of surgery and interviews internationally recognised professionals in their own fields. He also features conversations with a select group of esteemed surgeons who are recognised for their impact on effective training – both giving and receiving – has had on their career and their legacies. Role modelling, situation awareness and team playing are key to reading any training scenario and David will discuss with his guests how a variety of skills required across a huge range of industries can benefit discussions and offer best practice in Surgical Training.
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Content ArticleSurgical fires, which in the perioperative environment is a fire that occurs on or in a patient while in the operating theatre, are recognised as an international patient safety concern. This is due to the risks of injury to both patients and healthcare professionals. Surgical fires are categorised as either airway or non-airway and occur most commonly in the head, face, neck, upper chest or during ENT surgical procedures. The Association for Perioperative Practice (AfPP) along with a coalition of patient safety focused organisations are calling for more to be done to prevent surgical fires. Lindsay Keeley, patient safety and quality lead for the AfPP, explains why such incidents must be classified as ‘Never Events’, the common causes of surgical fires and the AfPP recommendations and standards for safe use of devices.
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Content ArticleWhere a new or under-recognised risk identified through the NHS England's review of patient safety events doesn’t meet the criteria for a National Patient Safety Alert, NHS England look to work with partner organisations, who may be better placed to take action to address the issue. To highlight this work and show the importance of recording patient safety events, they publish regular case studies. These case studies show the direct action taken in response to patient safety events recorded by organisations, staff and the public, and how their actions support the NHS to protect patients from harm.
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Content Article
Surgical fires are a serious a patient safety issue. In this blog, Patient Safety Learning analyses a recent response from Maria Caulfield MP, Minister for Patient Safety and Primary Care, to several questions tabled in the House of Commons about surgical fires in the NHS, and outlines the need for further action to prevent these incidents.- Posted
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Content ArticleThe Center for Outcomes and Patient Safety in Surgery (COMPASS) in the USA combines clinical collaboration and data to ensure, amongst all surgical and procedural colleagues, the safest, most appropriate and effective and highest quality procedure for every patient, every time. It aims to continuously strengthen the care that our patients receive through the measurement and analysis of surgical outcomes and data. COMPASS is composed of clinicians representing all Massachusetts General Hospital surgical specialties.
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Content ArticleThere are many respects in which the modern medical system is not fit for purpose and poses a threat to human health. In so many situations, our superficial assumptions about medicine are wrong. Having more tests to identify disease is often not better than leaving those “well enough” alone, labelling people with a specific disease may not be helpful, and more medicine may not be better than less medicine or no medicine at all. In our eagerness to intervene, we can end up doing harm. This fits with the estimation that around 30% of medical care is ineffective and another 10% is harmful. But why do doctors recommend tests, or diagnose and prescribe treatments that don’t help people? Ian A Harris, an orthopaedic surgeon, and Rachelle Buchbinder, a professor of clinical epidemiology, discuss in this BMJ opinion article.
