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News ArticleA London hospital hit by a COVID-19 outbreak that required 70 staff to self-isolate has been ordered to take stringent measures to control infection. Hillingdon Hospital NHS Foundation Trust declared a COVID-19 outbreak in July and revealed that 70 staff members, some of whom had tested positive, were self-isolating. Ambulances were forced to divert patients to other emergency departments. An investigation later found that a nurse who had COVID-19 unwittingly infected 16 others during a training session on 30 June, described by one doctor as a “super spreading event.” The Care Quality Commission (CQC), which carried out an unannounced inspection on 4-5 August, has used its urgent enforcement powers to place conditions on the trust’s registration to protect patients and staff. Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said, “We found a number of concerns relating to infection control and this is why we have taken action to ensure the safety of patients, staff and visitors." “We have imposed urgent conditions upon the trust’s registration and expect the trust to focus on making the required improvements as a matter of priority. We will return to inspect and ensure that action has been taken and that improvements have been made and are being sustained.” The trust has been told it must ensure that staff and patients observe social distancing, must place personal protective equipment (PPE) in easily accessible places, and must make sure that staff wear PPE before going into high risk areas. Read full story Source: BMJ, 9 September 2020
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News ArticleA risk calculator that takes seconds to produce a score indicating a COVD-19 patient’s risk of death could help clinicians make care decisions soon after patients arrive in hospital, according to a large study conducted by a consortium of researchers across the UK. As UK COVID-19 cases rise, schools reopen and the weather gets colder, doctors at UK hospitals are expected to see an influx of coronavirus patients. Patients with COVID-19 behave very differently to patients with other conditions such as flu and bacterial pneumonia, said Dr Antonia Ho of the University of Glasgow, one of the study’s authors, and it is very challenging for doctors managing this unfamiliar disease to accurately identify those who are at high risk of deterioration or who can ride out their illness at home. “So having a tool that … can help clinicians at the front door to accurately group patients who are coming in with COVID-19 into four distinct risk categories – low, intermediate, high and very high risk – is hugely valuable,” she added. “Having an accompanying low-risk score will provide that doctor with increased confidence that the vast majority of people, patients with that low-risk score, will come to no real harm.” Read full story Source: The Guardian, 9 September 2020
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Content ArticleThis document from the Department of Health and Social Care (DHSC) sets out how health and care systems can ensure that people: are discharged safely from hospital to the most appropriate place. continue to receive the care and support they need after they leave hospital. It replaces ‘Coronavirus (COVID-19) hospital discharge service requirements’ published on 19 March 2020.
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News ArticleHundreds of women with breast cancer in London were not picked up by routine screening as services closed during the lockdown, officials have estimated. Data from NHS England and Improvement’s London office said it expected 450 people to have breast cancer and have gone undiagnosed because of the heavily reduced amount of screening at the height of the outbreak. It was included in a letter from officials to local health system leaders, seen by HSJ. It said the figure was an estimate based on the 115,000 routine breast screenings that would have taken place between late March and the end of June and which had to be re-scheduled. London represents around 15% of England’s population, so a nationwide estimate would run into thousands. Responding to the figures, Breast Cancer Now chief executive Baroness Delyth Morgan said: ”While it’s encouraging that the breast screening programme in London is now back up and running, we are concerned to hear of the hundreds of potential delayed cancer diagnoses as a result of disruption due to the pandemic. The earlier breast cancer is diagnosed, the more likely treatment is to be successful." “With over a hundred thousand people missing out on vital breast screening during the pandemic in London alone, we urge the government to ensure there is sufficient capacity in the already-stretched workforce to meet the huge backlog and to avoid any cancers going undetected for longer.” Read full story (paywalled) Source: HSJ, 9 September 2020
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EventThis is the first of a series of webinars Patient Safety Learning, Health Plus Care and BD are holding on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline healthcare workers, clinical leaders and patient safety experts. COVID-19 has had a devastating impact on access to non-Covid care and treatment. We know there are over a million extra patients awaiting hospital treatment. The NHS has issued guidance for ‘accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter.’ In this webinar we will be discussing these issues with front-line clinicians and patient safety experts. Read Patient Safety Learning's accompanying blog that sets out some key points to inform the webinar. Registration
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News ArticleThe development of a promising COVID-19 vaccine has been put on hold due to an adverse reaction in a trial participant. A spokesman for AstraZeneca, the company working with a team from Oxford University, told the Guardian the trial has been stopped to review the “potentially unexplained illness” in one of the participants. The spokesman stressed that the adverse reaction was only recorded in a single participant and said pausing trials was common during vaccine development. “As part of the ongoing randomised, controlled global trials of the Oxford coronavirus vaccine, our standard review process was triggered and we voluntarily paused vaccination to allow review of safety data by an independent committee,” the spokesman said. “This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials. In large trials illnesses will happen by chance but must be independently reviewed to check this carefully." “We are working to expedite the review of the single event to minimise any potential impact on the trial timeline. We are committed to the safety of our participants and the highest standards of conduct in our trials.” Read full story Source: The Guardian, 9 September 2020
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Content ArticleThe rate at which nursing and ambulance staff are leaving the NHS is increasing. The number of nurse vacancies has risen to over 40,000 – a record high. The ambulance service has recorded an 80% per cent increase in staff leaving the profession since 2010. These rates are unequally distributed across professions, specialties and geographical regions, introducing inevitable inequalities in patient care. This Efficiency Research project aims to use this variation to detect underlying contributory factors for better or worse nurse and ambulance staff retention, and determine its effect on patient outcomes. A research team from Staffordshire University will use their experience of applying ‘big data’ analytics and unifying large datasets from three previous studies on the effect of nurse staffing on patient safety. Projects began in 2019 and will run until December 2023.
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News ArticleA leading health expert has suggested ministers have “lost control of the virus”, after the UK recorded it’s largest 24-hour spike in COVID-19 cases since 23 May. Government figures showed there have been a further 2,988 lab-confirmed cases of coronavirus in the UK as of 9am on Sunday. This brings the total number of confirmed cases in the UK to 347,152. Sunday's figure is the highest since May 22 when 3,287 cases were recorded, and is also the first 24-hour period when cases passed 2,000 since the end of May. The tally was an increase on Saturday's figures of 1,813 new cases. Prof Gabriel Scally, a member of the Independent Sage group and a former NHS regional director of public health for the south-west, warned that government ministers had “lost control of the virus”. “It’s no longer small outbreaks they can stamp on,” he told The Guardian. “It’s become endemic in our poorest communities and this is the result. Shadow health secretary Jonathan Ashworth called upon the government to respond to the sharp spike. He added that it was “a stark reminder that there is no room for complacency in tackling the spread of the virus”. “This increase, combined with the ongoing testing fiasco where ill people are told to drive for miles for tests, and the poor performance of the contact tracing system, needs an explanation from ministers,” he said on Sunday. Read full story Source: The Independent, 7 September 2020
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News ArticleGreater NHS support is needed for people chronically ill for months with COVID-19 symptoms, experts have told BBC Radio 4's File on 4. The Royal College of GPs is calling for a national network of "post-Covid" clinics to help such people. But less than 12% of 86 NHS care commissioning groups asked by the BBC said they were running such services. NHS England said it was "rapidly expanding new and strengthened rehab centres". Tim Spector, professor of genetic epidemiology at King's College London and leader of the Covid Symptom Study app, said around 300,000 people in the UK have reported symptoms lasting for more than a month - so called "long Covid". He added that data from the app showed around 60,000 people have been ill for more than three months. However, many of these people may not have been tested for Covid. The government moved away from community testing on 12 March, instead only testing those admitted to hospital. That meant people who recovered from suspected coronavirus at home were unable to access tests. Elly MacDonald, 37, from Surbiton, was training for the London Marathon when she first developed what she believes were Covid symptoms on 21 March. More than five months on, she still suffers from breathlessness and extreme fatigue, but has not received a positive test result - because community testing was re-introduced too late for it to detect her illness. She changed her GP practice after initially feeling she was not being helped. Elly said: "Just knowing that I actually have people who are taking me seriously - that's been very important for my recovery. I just want my life back." Read full story Source: BBC News, 8 September 2020
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News ArticleIn April, when the coronavirus outbreak was at its peak in the UK and tearing through hospitals, junior doctor Rebecca Thornton’s mental health took a turn for the worse and she ended up having to be sectioned. Even now, three months later, she cannot face going back to her job and thinks it will take her a year to recover from some of the horrors she saw while working on a Covid ward in a deprived area of London. “It was horrendous,” Thornton recalls. “It’s so harrowing to watch people die, day in, day out. Every time someone passed away, I’d say, ‘This is my fault’. Eventually I stopped eating and sleeping.” Thornton’s case may sound extreme but her experiences of working through Covid are far from unique. More than 1,000 doctors plan to quit the NHS over the government’s handling of the pandemic, according to a recent survey, with some citing burnout as a cause. A psychologist offering services to NHS staff throughout the UK, who asked to remain anonymous, has witnessed the toll on staff. “I’ve seen signs of PTSD in some healthcare workers,” she says. “Staff really stood up to the plate and worked incredibly hard. It was a crisis situation that moved very quickly ... After it subsided a little bit, the tiredness became very clear.” Roisin Fitzsimons, who is head of the Nightingale Academy, which provides a platform to share best practice in nursing and midwifery, and consultant nurse at Guy’s and St Thomas’ NHS foundation trust, also worries about the looming threat of an uncertain future. “Are our staff prepared? Do they have the resilience to go through this again? That’s the worry and that’s the unknown. Burnout is hitting people now. People are processing and realising what they’ve gone through.” Read full story Source: The Guardian, 8 September 2020
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News ArticleCOVID-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists in Hong Kong showed. The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said. SARS-CoV-2 spreads mainly through respiratory droplets -- spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists in China have said infectious virus in the stool of patients may also play a role in transmission. The finding “highlights the importance of long-term coronavirus and health surveillance and the threat of potential fecal-oral viral transmissions,” Siew Chien Ng, associate director of the university’s Centre for Gut Microbiota Research, said in the statement. Read full story Source: Bloomberg, 7 September 2020
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EventuntilThis is a high-level, international virtual conference focused on patient safety and protecting health workers hosted jointly by Sovereign Sustainability & Development (SSD), RLDatix and the Saudi Patient Safety Center (SPSC). Registration
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News Article
Government deal for clear face masks to help people with hearing loss
Patient Safety Learning posted a news article in News
Around 250,000 clear face masks are set to be delivered to frontline NHS and social care workers to allow for better care to be provided to those who use lip-reading and facial expressions to communicate, whilst still ensuring staff and patients remain safe during coronavirus. The clear face masks will allow for improved communication with people with certain conditions like hearing loss, autism and dementia. Designed with an anti-fogging barrier to ensure the face and mouth are always visible, the see-through masks will help doctors, nurses and carers get important messages across to all patients clearly. An estimated 12 million people in the UK are thought to have hearing loss, while those who rely on facial expressions to support communication – such as people with learning disabilities, autism or dementia, or foreign language speakers and their interpreters – will also see benefit from the government deal. Minister for Care Helen Whately said: “Everyone using our remarkable health and care system deserves the best care possible and communication is a vital part of that." “This pandemic has posed numerous challenges to the sector, so we are always on the hunt for simple solutions to support those giving and receiving care." Read full story Source: National Health Executive, 7 September 2020 -
News Article
‘Confidential’ document warns second covid peak could hit NHS five times harder
Patient Safety Learning posted a news article in News
Modelling being used by NHS officials forecasts that hospital admissions could peak at five times the level seen in April without additional measures to control the virus, HSJ can reveal. In all scenarios presented, covid hospital admissions would remain high for an extended period of many months, even if new lockdown actions were taken. However, putting multiple measures in place could contain them to a peak of less than that seen in the spring, according to the work. They were included in a document marked “confidential” and included, apparently by accident, in public papers for Thursday’s meeting of Medway Foundation Trust board. Within hours of HSJ asking for more information, they were removed. They were badged with Kent and Medway Clinical Commissioning Group, the NHS body which oversees services for that area. The forecasts were marked as being “Kent and Medway level”, but were referred to as “regional scenarios”, indicating they may have been produced by regional teams of NHS England and Improvement. The trust’s board papers said its own planning for the coming months would make use of the three scenarios presented in the document. Read full story Source: HSJ, 7 September 2020 -
News ArticleThe lungs and hearts of patients damaged by the coronavirus improve over time, a study has shown. Researchers in Austria recruited coronavirus patients who had been admitted to hospital. The patients were scheduled to return for evaluation 6, 12 and 24 weeks after being discharged, in what is said to be the first prospective follow-up of people infected with COVID-19, which will be presented at today's European Respiratory Society International Congress. Clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, and lung function tests were carried out during these visits. At the time of their first visit, more than half of the patients had at least one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. But by the time of their next visit, 12 weeks after discharge, the symptoms had improved, and lung damage was reduced to 56%. Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study, said: "The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves." A separate presentation to the congress said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery. Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University in France, used a walking test to evaluate the weekly progress of 19 patients who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for pulmonary rehabilitation. She said: "The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients' walking and breathing capacities and muscle gain." Read full story Source: The Independent, 7 September 2020
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Content Article
BMJ: Living with COVID-19 (3 September 2020)
PatientSafetyLearning Team posted an article in Blogs
In this Editors choice piece from the BMJ, the author discusses the persisting and debilitating symptoms that many sufferers of COVID-19 are experiencing and how some are also facing further challenges of dismissive attitudes from doctors. -
Content ArticleIn this commentary, published by Infectious Diseases, authors argue that more support for research is needed on the trajectory of people recovering from COVID-19.
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News ArticleOver 1,000 doctors plan to quit the NHS because they are disillusioned with the government’s handling of the COVID-19 pandemic and frustrated about their pay, a new survey has found. The doctors either intend to move abroad, take a career break, switch to private hospitals or resign to work as locums instead, amid growing concern about mental health and stress levels in the profession. “NHS doctors have come out of this pandemic battered, bruised and burned out”, said Dr Samantha Batt-Rawden, president of the Doctors’ Association UK, which undertook the research. The large number of medics who say they will leave the NHS within three years is “a shocking indictment of the government’s failure to value our nation’s doctors,” she added. “These are dedicated professionals who have put their lives on the line time and time again to keep patients in the NHS safe, and we could be about to lose them.
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News Article
Covid death rates dropped as doctors rejected ventilators
Patient Safety Learning posted a news article in News
Death rates among seriously ill COVID-19 patients dropped sharply as doctors rejected the use of mechanical ventilators, analysis has found. The chances of dying in an intensive care unit (ICU) went from 43% before the pandemic peaked to 34% in the period after. In a report, the Intensive Care National Audit & Research Centre said that no new drugs nor changes to clinical guidelines were introduced in that period that could account for the improvement. However, the use of mechanical ventilators fell dramatically. Before the peak in admissions on 1 April, 75.9% of COVID-19 patients were intubated within 24 hours of getting to an ICU, a proportion which fell to 44.1% after the peak. Meanwhile, the proportion of ICU patients put on a ventilator at any point dropped 22 percentage points to 61% either side of the peak. Researchers suggested this could have been a result of “informal learning” among networks of doctors that patients on ventilators were faring worse than expected. Read full story Source: The Telegraph, 3 September 2020 -
News Article
Rights watchdog backs court action over Covid deaths in English care homes
Patient Safety Learning posted a news article in News
The human rights watchdog for England and Wales has backed a grieving daughter’s court action against the health secretary, Matt Hancock, over his handling of the coronavirus pandemic in care homes. Cathy Gardner, who lost her father, Michael Gibson, to COVID-19 in a care home that accepted hospital discharges, is seeking a judicial review of policies that she alleges “failed to take into account the vulnerability of care home residents and staff to infection and death, the inadequacy of testing and PPE availability”. The government denies acting illegally over care homes in England, where more than 15,000 people have died with confirmed or suspected COVID-19. But the Equalities and Human Rights Commission said the case “raises potentially important issues of public interest and concern as to the way in which the rights of care home residents have been and will be protected during the current coronavirus pandemic”. “The bereaved families group isn’t backing down in its call for a public inquiry and I am not backing down in my call for a judicial review into policies I believe led to deaths in care homes,” Gardner said. ”I am delighted the EHRC have written to the court. This is a Human Rights Act case.” Read full story Source: The Guardian, 3 September 2020 -
Content ArticleCancer and multiple non-cancer conditions are considered by the Centers for Disease Control and Prevention (CDC) as high risk conditions in the COVID-19 emergency. Professional societies have recommended changes in cancer service provision to minimize COVID-19 risks to cancer patients and health care workers. However, we do not know the extent to which cancer patients, in whom multi-morbidity is common, may be at higher overall risk of mortality as a net result of multiple factors including COVID-19 infection, changes in health services, and socioeconomic factors. This paper from Lai et al. predicts estimate of excess deaths in cancer patients related to the COVID-19 emergency using data from England, Northern Ireland and US.
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Content ArticleIn order to inform clinical and research practice in secondary care in light of the COVID-19 pandemic, an online survey was used to collect public opinions on attending hospitals. The survey link was circulated via the National Institute for Health Research (NIHR) Public Involvement (PPI) Leads network and social media. Data collection included self-identified risk status due to comorbidity or age, and 100 point Likert-type scales to measures feelings of safety, factors affecting feelings of safety, intention to participate in research, comfort with new ways of working and attitudes to research. Results for feelings of safety scales indicate two distinct groups: one of respondents who felt quite safe and one of those who did not. *Note: This article is a preprint and has not been peer-reviewed.
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News Article
Patients don’t feel safe in A&E, research finds
Patient Safety Learning posted a news article in News
Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020 -
Content Article
Stolen breaths (16 July 2020)
Patient Safety Learning posted an article in Improving patient safety
In this perspective for the New England Journal of Medicine, Harderman et al. recommend that healthcare systems engage, at the very least, in five practices to dismantle structural racism and improve the health and well-being of the black community and the country. -
News ArticleThe use of inexpensive steroids in treating patients hospitalised with COVID-19 has been found to reduce the risk of death by 20%, according to a new international study. The research encompassed seven clinical trials, which focused on three different types of anti-inflammatory corticosteroids, and was co-ordinated by the World Health Organization (WHO). Following the publication of the findings, the WHO issued new guidelines in which it recommended the use of corticosteroids as standard treatment for patients with “severe and critical” COVID-19. The study, analysed by the National Institute for Health Research (NIHR) at the University of Bristol, looked at patient mortality over a 28-day period after treatment. It found that corticosteroid treatment led to an estimated 20% reduction in the risk of death. Researchers said it was equivalent to about 68% of critically ill patients surviving after treatment with the steroids, compared to approximately 60% surviving without them. Jonathan Sterne, professor of medical statistics and epidemiology at the University of Bristol, said: “Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by COVID-19." Read full story Source: The Independent, 2 September 2020
