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Showing results for tags 'Surgery - Trauma and orthopaedic'.
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News Article
Hip fracture care too slow in some hospitals, study says
Patient-Safety-Learning posted a news article in News
There are big differences in how well patients with hip fractures are cared for by hospitals in England and Wales, a Bristol University study says. In some hospitals one in 10 people died within a month of surgery - more than three times worse than in the best. Getting patients into theatre quickly and out of bed the next day for physio are key ways to improve care. People should receive the same, high-quality care wherever they live, the researchers said. "If you get it right for older people with hip fractures, you're probably getting it right for older people in general," says Professor Celia Gregson, who led the study of more than 170,700 patients in 172 hospitals between 2016 and 2019. An NHS spokesperson said hip fracture care in the UK had "seen dramatic improvements in recent years". Read full story Source: BBC News (31 August 2022) -
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NHS waiting lists hiding 10m patients in need of follow-up care
Patient-Safety-Learning posted a news article in News
More than ten million patients are on “hidden” waiting lists for NHS care. There are 6.7 million patients on the official NHS waiting list, which includes people who have been referred by GPs for hospital treatment such as cataract or hip and knee surgery. However, data released by health service trusts under freedom of information laws suggests there are 10.3 million further patients who need follow-up care, illustrating the scale of the task facing the NHS. Louise Ansari, national director at the patient group Healthwatch England, said: “Waiting a long time for treatment can put a huge strain on patients and their loved ones. But this can be so much worse when there is ‘radio silence’ from the NHS, leaving people uncertain if their referral has been accepted, unclear about how long they may have to wait and often feeling forgotten.” Read full story (paywalled) Source: The Times (30 August 2022) -
Content ArticleRecommendations Early mobilisation Collaborative multidisciplinary working is needed to ensure that pain, hypotension and delirium do not hold back early progress in physiotherapy. Patients should be helped to get up by the day after surgery – such ‘mobilisation’ is key to patients’ wellbeing and avoidance of complications such as delirium, deconditioning and pressure damage. This mobilisation is just one element of the physiotherapy provided to patients, but it is the key measure that the National Hip Fracture Database (NHFD) will use to drive forward local quality improvement after Hip Sprint. Local therapy teams should review how they record patients’ progress, so that there is clear communication of patient outcomes to multidisciplinary team (MDT) colleagues and correct reporting to the NHFD. Intensive rehabilitation Hip fracture programmes should invest in early intensive rehabilitation to maximise the number of people who can be discharged directly home from the acute orthopaedic ward. Hospital physiotherapy teams should put in place systems to ensure that more intense rehabilitation includes attention to strength, balance and endurance, as well as mobility. Physiotherapists should consider how they are teaching and working with colleagues, as Hip Sprint found little evidence that therapy work is being delegated to other staff; a missed opportunity for multidisciplinary working. Local governance and quality improvement Physiotherapists, surgeons, anaesthetists, orthogeriatricians and nurses should all attend monthly hip fracture programme clinical governance meetings. Physiotherapists, surgeons, anaesthetists, orthogeriatricians and nurses should review their own unit’s Hip Sprint data at the NHFD and agree on a local quality improvement action plan. Staffing levels affect patient care, especially after the first postoperative day and at weekends, and physiotherapists should continue the transparent approach developed in Hip Sprint to highlight concerns if staffing limits their ability to deliver care as per NICE recommendations.
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News ArticleThe number of knee replacement operations carried out has dropped in regions of England with restrictions on surgery for overweight patients, with people in more deprived areas worst affected, researchers have found. Patients needing surgery but unable to lose weight are being denied surgery that could ease pain and increase mobility, the team from the University of Bristol said. Health campaigners expressed alarm, claiming the policy was a “blunt tool” being used to replace conversations between doctors and patients and risked exacerbating health inequalities. Over the past decade, rules have been brought in by some clinical commissioning groups (CCGs) across England to restrict access to hip and knee replacement surgery for patients who are overweight or obese. The study, funded by the National Institute for Health and Care Research, suggests that regions that introduced policy changes for access to knee replacement surgery based on a patient’s weight or BMI have seen a decline in surgery. The lead author, Joanna McLaughlin, of the Bristol Medical School, said: “Our study raises the concern that these policies are linked with worsening health inequalities with fewer NHS operations for the least affluent groups. “We could see the rates of surgery dropped for those worst off but increased for those who are best off, which correlates with more private surgery going on in those areas.” Read full story Source: The Guardian, 29 June 2022
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National Joint Registry: Surgeon and hospital profile
Patient Safety Learning posted an article in Surgery
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The National Joint Registry
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Patients asked to travel 200 miles in push to cut elective waits
Patient Safety Learning posted a news article in News
Long waiting times at Devon’s acute hospitals have forced commissioners to offer patients treatment 200 miles away in London in a bid to reduce the elective backlog. Devon Clinical Commissioning Group has secured extra capacity for patients requiring complex orthopaedic surgery under a new deal with the South West London Elective Orthopaedic Centre, located at Epsom General Hospital. The NHS-run orthopaedic centre is around 170 miles from Exeter in east Devon and 210 miles from Plymouth in west Devon. Many patients have declined to go, despite the CCG offering to cover their travel costs. It is the longest publicly reported distance patients are being sent for elective treatment in the NHS, with patients usually referred to neighbouring hospitals or integrated care systems if there is no capacity at their local provider. Nearly 1,500 patients in the Devon ICS have waited longer than two years for treatment. The latest national data for England showed nearly 23,000 patients had been waiting longer than two years in January. Read full story (paywalled) Source: HSJ, 8 April 2022 -
News Article
£3bn group of hospitals moves to centralise electives
Patient Safety Learning posted a news article in News
North west London’s acute trusts are exploring whether to set up a new elective orthopaedic centre in the region as they seek to capitalise on the concept of “fast-track” surgical hubs. Last week, a report to Imperial College Healthcare Trust’s board said a more “strategic, larger-scale” approach was being sought to improve capacity for more high-volume, low-complexity work across the sector. This covers the four acute trusts in the area, which now share a single chair, and have a total turnover of more than £3bn: Imperial, Chelsea and Westminster, London North West, and Hillingdon. The board report said leaders were exploring how best to establish the centre for the region while “maximising” planned surgery capacity overall, with the South West London Elective Orthopaedic Centre run by Epsom and St Helier University Hospitals Trust highlighted as a “well-established example”. Central Middlesex Hospital, which is operated by London North West University Healthcare Trust, has been identified as a preferred location for the centre, the report said. A project management team is also being set up to explore the options available before proposals are developed for broader consideration. It comes after 14 “fast-track” hubs were set up across hospitals in north west London to maximise theatre capacity, which predominantly focused on high-volume, low-complexity work surrounding specialties such as gynaecology, urology, orthopaedics and ear, nose and throat. The report to ICHT’s board warned that, without some “further intervention,” the number of patients awaiting orthopaedic surgery in north west London could increase to just under a fifth by 2030 from a current position of 12,000 people seeking inpatient or outpatient care. However, it added that a “large amount of work” was still required to explore the case for an elective orthopaedic centre, including establishing the best location and identifying capital and revenue funding and workforce requirements. Read full story (paywalled) Source: HSJ, 22 March 2022 -
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Woman screaming in pain waiting years for hip op
Patient Safety Learning posted a news article in News
"Seeing how much pain she's in is killing me," the mother of a woman waiting four years for a hip operation has said. It is only by screaming that Marie Morgan, from Carmarthenshire, can express her level of suffering. The 30-year-old, who has multiple brain conditions, can speak only a few words and needs round-the-clock care. "Her hip is out and is rubbing against bone... there's no socket there," Marie's mother Sandra said. "She can't travel because every time I move her she's screaming in pain. Marie has cerebral palsy, severe epilepsy and fluid on the brain and the constant agony caused by the wait has meant these conditions, including her seizures, have become "horrendous". Sandra said: "She used to be so happy, we used to go to the pool, play music... Now she's gone downhill. I don't think she can last much longer to be honest with you." Marie, from Penygroes, is on a waiting list to have surgery in Morriston Hospital, Swansea. Her mother said staff have told her she is considered to be high priority, but despite her best efforts, she is still in the dark about when the operation will happen. "They said because of Covid they weren't operating, now they say it's staff shortages so it's something all the time. "I feel I'm knocking my head against a wall. It's not fair, she's only 30 and suffering the way she is." Swansea Bay Health Board said it hoped to tackle the backlog by increasing capacity at one of its hospitals. Read full story Source: BBC News, 17 February 2022 -
News Article
Coroner concerned with Barts NHS trust after woman 'unlawfully killed'
Patient Safety Learning posted a news article in News
Barts Health NHS Trust has been told to take action to prevent future deaths after an elderly woman was unlawfully killed at one of its hospitals. East London acting senior coroner Graeme Irvine sent a report to the trust in which he raised concerns over the death of 78-year-old Surekha Shivalkar in 2018. The report follows an inquest into Mrs Shivalkar's death, which reached a narrative conclusion incorporating a finding of unlawful killing. A Barts spokesperson said the trust had made a number of changes after carrying out an investigation. Mrs Shivalkar underwent hip replacement revision surgery at Newham Hospital on September 28, 2018 in a procedure estimated to last between four and five hours, the coroner wrote. She had a number of serious conditions, including ischaemic heart disease, osteoporosis and chronic obstructive pulmonary disorder. But Mr Irvine said an inaccurate risk of death of less than 5% was given, as no formal risk assessment tool was used. The surgery took longer than seven and a half hours, during which time Mr Irvine said Mrs Shivalkar sustained a "prolonged and dangerous" period of hypotension, or low blood pressure. He said the anaesthetist failed to communicate this to the surgical team and agreed to prolong surgery at the six hour point. Mr Irvine said: "Poor communication between the orthopaedic surgical team and the anaesthetist during surgery led to a collective failure to identify a critically ill patient." Read full story Source: Newham Recorder, 17 January 2022 -
Content ArticleIn this report, the Coroner states their concerns as follows: No formal risk assessment tool was adopted to assess preoperative risk prior to Mrs Shivalkar's total hip replacement revision surgery. Despite policy changes at Barts Heath NHS Trust since 2018, there remains no requirement to utilise such a tool. Poor communication between the orthopaedic surgical team and the anaesthetist during surgery led to a collective failure to identify a critically ill patient. General and non-specific questions regarding the patient's welfare passed between the two teams but no targeted questions requiring clear factual responses were asked. Had such questions been put, a different outcome may have arisen. The Senior Consultant surgeon left the surgery prior to its conclusion, lengthening the procedure. The Consultant did not effectively communicate his reasons for leaving the surgery to the other members of the surgical team, neither did the surgical notes refer to his early departure. The Consultants statement to the court did not indicate that he had left the surgery before its conclusion. No system was in place to; assess whether a decision to leave surgery was appropriate, or to effectively monitor when a surgeon leaves theatre. This report was sent to the Royal London Hospital, Department of Health and Social Care, Royal College of Surgeons and Royal College of Anaesthetists.
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News ArticleSuicidal thoughts are three times as common in those living with a spinal cord injury in the UK, according to new research And yet, it’s estimated that only one third of people living with a spinal cord injury (SCI) are getting access to mental health support, and of those, 68% do not feel that support services available are able to meet their needs. These alarming statistics are taken from a new report, ‘It’s not just physical’ which was presented to parliament yesterday (17 November). The report shines a light on the mental health problems faced by people with spinal cord injuries in the UK today. It's calling on the NHS, government and other health policy makers to provide better mental health support services for people with spinal cord injuries – and their unpaid carers – as a matter of urgency. Nik Hartley, Spinal Injuries Association CEO said: “We are at risk of failing thousands of people in the UK living with a spinal cord injury. Our new report highlights that psychological damage caused by a SCI is, at best, considered as an afterthought, and at worst, completely ignored by the medical profession. We need urgent action and for services to be sufficiently specialised to support the thousands of people living with this type of injury before it is too late.” Read full story Source: Spinal Injuries Association, 17 November 2021
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Findings: 28% of people living with a SCI experience suicidal ‘ideation’ – frequent thoughts or ideas about committing suicide 47% of people living with a SCI reported experiencing mental health problems in one or more of the assessed mental health conditions 68% of people living with a SCI who accessed NHS psychological support have stopped because it was either “not appropriate for their condition” or “making their condition worse” It’s really not just physical. The findings of this seminal research is a wake-up call for the NHS, healthcare planners and policymakers to provide better mental health support services for SCI people - and their unpaid carers - as a matter of urgency. -
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Opioid pain relief 'soared during pandemic' for some patients
Patient Safety Learning posted a news article in News
The use of opioids for pain relief soared during the pandemic as some patients waited longer for surgery, according to new research. The University of Aberdeen team focused on more than 450 patients due to have hip or knee replacement surgery. They said waiting times for these procedures increased by an average of 90 days and that the numbers of patients using opioids while waiting for surgery increased by 40% compared to pre-pandemic levels. The research, published in the BMJ Quality and Safety, looked at data collected from 452 NHS patients from the north east of Scotland. The university's Luke Farrow, who led the research, said alternative ways of managing severe arthritis pain needed to be found "urgently" for those waiting for this kind of surgery. Read full story Source: BBC News, 15 November 2021 -
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Northern Ireland health system "one step from chaos"
Patient Safety Learning posted a news article in News
"Bodies would have been piling up" if the Covid vaccine had not been available, the director of intensive care at Belfast City Hospital has said. Dr George Gardiner, a consultant, also said his biggest fear would be having to stop routine cancer surgery. He has called for an end to "tribal politics" in Northern Ireland to allow transformation of the health service, so that cancer and coronavirus can be tackled in tandem. He said the system was currently "one step from chaos" and warned hospitals will not cope with winter if Covid numbers continue to rise. "We need to get everyone who can take a vaccine to take it now before the winter pressures are on us," Dr Gardiner added. "The cancer surgery that we are doing at the minute is life saving. A few more Covid admissions, which could be prevented, will cause us to stop operating because we simply haven't got the capacity to do both." Read full story Source: BBC News, 7 September 2021 -
Content ArticleFollowing incidents where bottles of liquefied phenol 80% were either confused with other medication or caused burns when spilt, this alert asks providers to eliminate its use and to follow professional guidance to use safer alternatives. Phenol, a caustic compound used for its antimicrobial, anaesthetic, and antipruritic properties, is highly toxic and corrosive. Liquefied phenol 80% can cause burns, severe tissue injury and is rapidly and well absorbed causing systemic toxicity. It is most commonly used in podiatry and orthopaedic foot surgery for destroying the nail matrix. Actions to be completed as soon as possible and no later than 25 Feb 2022: Identify where liquefied phenol 80% is used and update procedures/guidelines to substitute use for a safer, suitable alternative. Ensure clinical areas have stock of agreed safer alternatives and then remove bottles of liquefied phenol 80% from clinical areas, and update stock lists. Amend electronic prescribing systems to ensure liquefied phenol 80% cannot be prescribed. Amend current purchasing systems, and introduce ongoing controls on purchasing, to ensure liquefied phenol 80% cannot be purchased inadvertently via the pharmacy department or any alternative purchasing route.
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