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Content ArticleLast November’s HSJ Patient Safety Virtual Congress focused on the COVID-19 virtual ward model, which enables the early identification and timely management of deteriorating patients in the community - a critical step in reducing avoidable deaths from all conditions. If you missed the vital discussion, you can check it out below.
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Content Article"To me, leadership isn’t defined by how nice or popular you are. It’s defined by outcomes. That’s how I judge my own successes and failures. In this pandemic—if death and collateral damage are the barometers, as they should be—the leadership teams have failed us all." An article published in the BMJ from Partha Kar, a consultant in diabetes and endocrinology.
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Content ArticleDuring the first wave of the COVID-19 pandemic in England, several population characteristics were associated with an increased risk of death from the virus, including age, ethnicity, income, deprivation, care home residence and housing conditions. Public health agencies wanted to understand how these vulnerability factors were distributed across their communities. Daras et al. from the NIHR Applied Research Collaboration North West Coast (NIHR ARC NWC) analysed 6,789 small areas in England and assessed the association between COVID-19 mortality in each area and five vulnerability measures relating to ethnicity, poverty, and prevalence of long-term health conditions, living in care homes and living in overcrowded housing. They developed a Small Area Vulnerability Index (SAVI) modelling tool, which forecasts the vulnerability of the local population to the virus. The data identified noticeably higher levels of vulnerability to COVID-19 clustered within specific communities in the North West, West Midlands and North East regions.
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Content ArticleOn 21 January 2021, the Office of National Statistics (ONS) published its latest experimental estimates of long COVID symptom prevalence in the general population, using data from 9,063 respondents to the UK Coronavirus Infection Survey (CIS) testing positive for COVID-19 to 14 December 2020. The CIS is a survey sample of respondents randomly selected from the UK population (excluding communal establishments) who are followed-up weekly for the first month from enrolment, followed by monthly for a up to a year. At each visit, respondents are swab tested for COVID-19 and describe their current symptoms (from a list of 12 common COVID-19 symptoms) to the interviewer. The ONS estimated time-to-symptom-discontinuation using survival analysis techniques. Discontinuation was defined as the first post-infection occurrence of the respondent not reporting any symptoms for two consecutive visits (that is, the visit defining the date of discontinuation plus the next one). To allow time from infection to symptom onset, the ONS tracked symptoms reported at the visit where the respondent tested positive for COVID-19 or within the next month.
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Content ArticleUrgent action is needed in the NHS to meet a ballooning backlog of procedures put on hold during the pandemic and build a more resilient health care system. This report from Reform, produced jointly with Edge Health, shows the scale of the challenges the NHS faces: 6 million fewer patients were referred to treatment in 2020 than in 2019 • 10 million patients could be on a waitlist by April By April, 52-week waits for care are projected to have risen 12,008% since March 2020 (by December they had already risen by 7139%) Cancellations of diagnostic testing and delayed treatment may lead to 1,660 extra deaths from lung cancer alone.
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Content ArticleA research study with 20,000 people found people who read the advice in Germ Defence are less likely to catch viruses. If they do become ill, the illness is likely to be less severe. Germ Defence has been developed by health experts in UK universities.
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Content ArticleThe NIHR-supported RECOVERY trial has shown that tocilizumab – an anti-inflammatory rheumatoid arthritis treatment – reduces the risk of death for hospitalised patients with severe COVID-19. Researchers also found that the drug reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation. Last year, the RECOVERY study was the world’s first to show that dexamethasone – a cheap and available steroid – reduces the risk of dying from COVID-19. The latest results from the study also suggests that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid – such a dexamethasone – alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation. RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care. The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab - beyond those critically ill on mechanical ventilation. For this preliminary report, information on the primary outcome was available for 92% of patients. Report has not been peer-reviewed yet.
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Content ArticleMore than 1·8 million lives have been lost due to COVID-19. Two frontrunner vaccines from Moderna and Pfizer-BioNTech promise some relief, with data suggesting 95% efficacy,1 and have been granted emergency use authorisations in several countries. In an open letter responding to these developments, participants in COVID-19 vaccine trials argued that those who received placebos should be unmasked and given priority access to authorised vaccines. The letter cited the American Medical Association's Code of Medical Ethics, which highlights the importance of minimising the time research participants spend in a placebo group. Fulfilling these requests could help to foster trust in medicine and research, reward those who take risks for the many, and prevent future harm from COVID-19 for these participants. However, granting these requests also comes with tradeoffs and highlights competing interests inherent in vaccine development. Importantly, these requests also reveal shortcomings in bioethical resources, particularly clinical equipoise conceptualisations. Friesen et al. discuss this further in this Lancet correspondence.
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Content ArticleThe scale of the emergency response to the COVID-19 pandemic has been extraordinary, but what comes next? The King's Fund spoke with people involved in response efforts for disasters from around the world, from the Christchurch earthquakes in New Zealand to the Grenfell Tower fire in London, to understand what the health and care system can learn from the experience of recovery from other disasters as it responds to the pandemic.
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Content ArticleInside the US Trump administration, sensible ideas for how to manage a massive, unprecedented distribution of vaccinations were no match for bureaucratic knife fighting, gung ho hubris, and a knee-jerk aversion to strong federal action.
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Content ArticleThe COVID-19 pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. ‘Post-acute COVID’ (also known as ‘Long COVID’) is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness. Dani et al. describe a series of individuals with symptoms of ‘Long COVID’, and posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. They suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. They present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.
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Content ArticleIn The Lancet correspondence, Norton and colleagues on behalf of the ISARIC and GloPID-R Long COVID Forum Working Group, write following an international, multistakeholder forum, in which peoples’ voices were central, to expand the call to action and to identify how we can prevent long COVID from becoming the long-lasting legacy of COVID-19.
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Content ArticleThe outbreak of COVID-19 changed everything, for everyone, across the globe. New ways of working and every day challenges were a reality for us all, none more so than for key workers. But the pandemic also highlighted the role whistleblowing plays in all of our lives and the perils of not listening to whistleblowers and their concerns. From the late Wuhan doctor, Dr Li Wenliang, who selflessly tried to warn of the dangers of the coronavirus outbreak (and was later reprimanded for his “false comments”), to our own NHS staff and care home workers speaking out about PPE safety concerns and working conditions, and the furlough fraud crisis, whistleblowing has been centre-stage during COVID-19. This report from Protect considers the concerns whistleblowers raised with our Advice Line in the first six months of lockdown in the UK (March - September 2020).
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Content Article“Long Covid” was first used by Elisa Perego as a Twitter hashtag in May to describe her own experience of a multiphasic, cyclical condition that differed in time course and symptomatology from the bi-phasic pathway discussed in early scientific papers, which focused on hospitalised patients. Just three months later, following intense advocacy by patients across the world, this patient made term has been taken up by powerful actors, including the World Health Organization. Politicians have used it too: Matt Hancock, UK health secretary, explained to a parliamentary committee that “the impact of long covid can be really debilitating for a long period of time.” “Long Covid” has clearly struck a chord. However, it’s not the only term being used to describe persistent symptoms: we’ve also seen post-acute COVID-19, postcovid syndrome, and chronic COVID-19. In this BMJ Opinion article, Elizabeth Perego and colleagues explains why, as patients and professionals, they see “Long Covid” as better able to navigate the socio-political, as well as clinical and public health challenges, posed by the pandemic in the coming month.
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Content ArticleA study from Chamberlain et al. examined post-traumatic stress disorder (PTSD) symptoms in 13 049 survivors of suspected or confirmed COVID-19, from the UK general population, as a function of severity and hospital admission status. Compared with mild COVID-19, significantly elevated rates of PTSD symptoms were identified in those requiring medical support at home, those requiring hospital admission without ventilation and those requiring hospital admission with ventilator support. Intrusive images were the most prominent elevated symptom. Adequate psychiatric provision for such individuals will be of paramount importance.
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Content ArticleDespite the application of a huge range of human factors (HF) principles in a growing range of care contexts, there is much more that could be done to realise this expertise for patient benefit, staff well-being and organisational performance. Healthcare has struggled to embrace system safety approaches, misapplied or misinterpreted others, and has stuck to a range of outdated and potentially counter-productive myths even has safety science has developed. One consequence of these persistent misunderstandings is that few opportunities exist in clinical settings for qualified HF professionals. Instead, HF has been applied by clinicians and others, to highly variable degrees—sometimes great success, but frequently in limited and sometimes counter-productive ways. Meanwhile, HF professionals have struggled to make a meaningful impact on frontline care and have had little career structure or support. However, in the last few years, embedded clinical HF practitioners have begun to have considerable success that are now being supported and amplified by professional networks. The recent COVID-19 experiences confirm this. Closer collaboration between healthcare and HF professionals will result in significant and ultimately beneficial changes to both professions and clinical care.
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Content ArticleVaccination is the single most effective way to reduce deaths and severe illness from COVID-19. A national immunisation campaign has been underway since early December 2020. All vaccines and medicines have some side effects. These side effects need to be continuously balanced against the expected benefits in preventing illness. The Medicines and Healthcare products Regulatory Agency (MHRA)'s role is to continually monitor safety during widespread use of a vaccine. They have in place a proactive strategy to do this. They also work closely with our public health partners in reviewing the effectiveness and impact of the vaccines to ensure the benefits continue to outweigh any possible side effects. Part of their monitoring role includes reviewing reports of suspected side effects. Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The nature of Yellow Card reporting means that reported events are not always proven side effects. Some events may have happened anyway, regardless of vaccination. This is particularly the case when millions of people are vaccinated, and especially when most vaccines are being given to the most elderly people and people who have underlying illness.
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Content ArticleUK Biobank, commissioned by the Department for Health and Social Care, has produced its final round of results after testing over 20,000 people for coronavirus antibodies. The study is tracking the spread of the virus across England, Scotland and Wales over 6 months. The UK Biobank COVID-19 antibody study will analyse samples from people participating in its study to assess antibody levels over time. The data and insights from this study will help the government understand how long COVID-19 antibodies stay in the blood, how strong they are and what this could mean for potential immunity.
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Content ArticleAt the beginning of 2020, before the coronavirus (COVID-19) started spreading, many people had no idea they may own a face mask in their lifetime. Today, almost everyone has one. In the Asian countries where people are used to wearing face masks, many took them in their stride. Questions lingered in other parts of the world as some expressed doubts about the value of face masks and coverings in slowing down the coronavirus spread. As face masks become the new normal in many parts of the world, many different types of masks, including home-made cloth masks, surgical masks, and cone style masks, have become more common. To an ordinary person who has little knowledge about masks, it can be challenging to determine the right mask for adequate protection. Shandong Deqi Intelligent Technology Co.,Ltd, a surgical face mask making company in China, in this article answers some of the most common questions about face masks and face protection. With all the fake news and incorrect information spreading around, they aim to separate fact from myth.
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Content ArticleIn the autumn of 2020, the Care Quality Commission (CQC) looked at how providers were working together in urgent and emergency care (UEC). Winter and the pandemic now place UEC services under exceptional pressure. It's against this context CQC are publishing examples of the innovation and creative approaches they've found so far.
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Content Article
Ergonomics to support the COVID-19 response
Patient Safety Learning posted an article in Process improvement
Without embedded experience within healthcare organisations the application, evidence and business case for human factors in NHS decision-making will not be developed. The concerns about availability of ventilators offered the first opportunity to support the NHS. A rapid response project was initiated to support the design, development, usability testing and operation of new ventilators. This article from the Chartered Institute of Ergonomics & Human Factors looks at their response to the rapidly manufactured ventilators and their five-step approach response that was used to influence both strategy and practice to address concerns about changing safety standards and the detailed design procedure with ventilator manufacturers. It also discusses organisational learning and achieving sustainable change and the next steps in patient safety. -
Content ArticleThis report has been developed by the Patient Coalition for AI, Data and Digital Tech in Health, which aims to unite representatives from patient advocacy groups, including Patient Safety Learning, Royal Colleges, medical charities, industry and other stakeholders committed to ensuring that patient interests. The report highlights that uptake of digital health technologies has been limited, while patient experience of technologies including video conferencing and mobile apps has been mixed. Although patients strongly believe in the value of digital health, there are still significant concerns about using it, particularly around data collection and sharing.
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Content ArticleGerm Defence is a website that has been developed by health experts in UK universities to help you find out how to reduce this risk of catching coronavirus or passing it on to others. After a bit of practice the ideas and advice in Germ Defence will become habits and they will help protect you from coronavirus - and other germs in the future.A research study with 20,000 people found:People who read the advice in Germ Defence are less likely to catch virusesIf they do become ill, the illness is likely to be less severe.
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Content ArticleThe Health Foundation policy tracker provides a description and timeline of national policy and health system responses to COVID-19 in England in 2020. The full tracker includes data on what changes have been introduced, when, why, and by whom – as well as how these changes have been communicated by policymakers. We track policy changes in five areas – from health and care system changes to wider social and economic policy.
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Content ArticleThis report to Congress details a strategy to achieve the principal purpose and objective of Operation Warp Speed (OWS): ensuring that every American who wants to receive a COVID-19 vaccine can receive one, by delivering safe and effective vaccine doses to the American people beginning January 2021.
