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Content ArticleHospitals are currently planning to resume or expand surgical services that were cancelled during the recent COVID-19 crisis. While emergency surgery will need to continue to be performed within current restrictions, other operations might now be feasible as resources become available. The following checklist from the Royal College of Surgeons of England introduces some of the main criteria that should be taken into account in the initial stages of resuming planned surgery.
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Content ArticleThe COVID-19 pandemic has suddenly challenged many healthcare systems. To respond to the crisis, these systems have had to reorganise instantly, with little time to reflect on the roles to assign to their patient safety (PS) and quality improvement (QI) experts. In many cases, staff who had a background in clinical care was called to support wards and critical care. Others were deemed “non-essential” and sent back to work from home, while their programmes were placed in hibernation mode. This has meant that many QI and PS experts with skills to offer in their field have ended up carrying out tasks unrelated to the current crisis.
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Content ArticleThis Royal College of General Practitioners (RCGP) report calls on the four governments of the UK to each produce a comprehensive plan to support GPs in managing the longer-term effects of COVID-19 in the community.
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Content Article
GOV.UK: Coronavirus testing dashboard
Patient Safety Learning posted an article in Data, research and statistics
Regularly updated data from GOV.UK on tests processed and testing capacity in the UK. -
Content ArticleLesley Flatley, reflects on some of the challenges and key learnings from leading in isolation, as a manager in an independent care home, during the pandemic. "Our experiences of the pandemic so far have been extremely challenging, but we must continue to improve and build on new ways of working to ensure that staff and residents are supported."
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Content ArticleIn this interview, Dr Jake Suett talks about his experience of persisting and debilitating symptoms after he was suspected to have contracted COVID-19. Additional reading: Patient safety concerns for Long COVID patients (6 July 2020) Press release: Patient Safety Learning calls for urgent action to ensure Long COVID patients are heard and supported (6 July 2020) My experience of suspected 'Long COVID' (6 July 2020) Dismissed, unsupported and misdiagnosed: Interview with a COVID-19 ‘long-hauler’
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Content ArticleThe scale of the challenge facing the NHS after the first wave of COVID-19 in England is only just coming to light. The NHS adapted at speed to redeploy staff, change estate configurations, reduce non-COVID-19 face-to-face appointments and redesign patient pathways. The deployment of the NHS physician workforce provides an insight into the NHS response. In the middle of May, 32% of Royal College of Physicians (RCP) members reported working in a clinical area that was different from their normal practice.By the start of June this had reduced by 10% to 22%, but that still means one-fifth of the workforce were working outside their usual area. This has knock-on effects for patients and the resumption of services. The RCP, in partnership with our specialist societies, has been working with NHS England to plan specialty-specific restart activity. This is based on different scenarios regarding specialty capacity across the country, and the impact of COVID-19 is being felt unevenly. Consultants in respiratory medicine and gastroenterology expect it to take 2 years to recover from the backlog created by COVID-19, while those in cardiology are expecting it to take 18–21 months. Providing accurate estimates and projections about what the next 12 months hold for the NHS is difficult, as we can’t be certain about whether there will be future outbreaks and waves of COVID-19. This report highlights just why it is so important that the government, the NHS and politicians openly discuss the significant unmet need in the patient population.
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Content ArticleWeeks and months after having a confirmed or suspected Covid-19 infection, many people are finding they still haven’t fully recovered. Emerging reports describe lingering symptoms ranging from fatigue and brain-fog to breathlessness and tingling toes. So why does Covid-19 cause lasting health problems? In this podcast, Ian Sample discusses some of the possible explanations with Prof Danny Altmann, and finds out how patients might be helped in the future.
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Content ArticleThe purpose of this guide from the Chartered Institute of Ergonomics and Human Factors (CIEHF) is to help people working in the health and social care ecosystem capture valuable practice and improvements made during their response to COVID-19. The aim is to contribute to organisational change at a policy, strategic and operational level. If left too late, there is a real danger that positive change is not documented and will be lost as the health system emerges from the pandemic.
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Patient safety concerns for Long COVID patients (6 July 2020)
PatientSafetyLearning Team posted an article in Blogs
An increasing number of people with confirmed or suspected COVID-19 are continuing to struggle with prolonged, debilitating and sometimes severe symptoms months later.[1] Many were never admitted to hospital and have instead been trying to manage their symptoms and recovery at home. These patients are sometimes referred to as the ‘long-haulers’ or described as having ‘post-acute’, ‘chronic’ or ‘long-term’ COVID-19. Here, we will use the term ‘Long COVID’. With social distancing restrictions still in place, patients in the UK and across the world have been turning to social media support networks[2] to connect with others who are experiencing similar challenges. These patients have raised very credible concerns about the care they are receiving[3] and the uncertainties they face. Their concerns are revealing many implications for patient safety. We have recently shared on the hub the story of Dr Jake Suett[4], one of the many people experiencing symptoms of Long COVID. When we conclude this article, we will return to his story and highlight the changes that he is calling for. However, first, we will focus on the patient safety aspects of Long COVID, highlighting key areas of concern and action needed (a full list of actions can be found summarised here). -
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My experience of suspected 'Long COVID'
PatientSafetyLearning Team posted an article in Blogs
In this blog, intensive care doctor Jake Suett draws on his personal journey and that of others to highlight the prolonged and frightening symptoms many patients with confirmed or suspected COVID-19 are experiencing. Jake outlines his concerns and sets out recommendations for future action to address the needs of these 'Long COVID' patients. Included is an example letter that can be adapted by others to call on MPs to raise awareness of those suffering persisting symptoms of COVID-19.- Posted
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Content ArticleSince the rise of COVID-19 in the UK, many consultations between surgeons and patients take place remotely, via phone or video. These consultations include pre-operative assessments, discussions between surgeons and patients about the benefits and risks of their surgery, and gaining the patient’s consent to proceed with treatment. This transition to remote consultations has been central in the healthcare system’s effort to prevent transmission of COVID-19, and has required a series of adjustments by patients, hospitals and members of the surgical team. However, when it comes to the consent process, the same principles and requirements should apply as set out by the GMC and The Royal College of Surgeons of England, regardless of whether the conversation takes place face-to-face or via phone or video. In addition, during the COVID-19 period, the consent discussion should include further considerations to ensure that patients have the necessary information to make an informed decision about their treatment. This guide sets out the main principles of the consent process and provides advice on what additional information should be included in conversations with patients while COVID-19 is still prevalent in society.
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Emerging evidence on health inequalities and COVID-19: May 2020
Claire Cox posted an article in Health inequalities
A recent Health Foundation long read suggests that the COVID-19 pandemic could be a watershed moment in creating the social and political will to build a society that values everyone’s health – now and in the long term. The global pandemic and the wider governmental and societal response, is certainly bringing health inequalities into sharp focus. And it has been apparent from the early stages of the pandemic that some groups are at much higher risk of catching and dying from the virus than others. Factors such as age, gender, ethnicity and socioeconomic deprivation are all known to be important. Critically, these factors combine in complex ways to put some people at much greater risk. In addition, the measures taken to control the spread of the virus are having unequal socioeconomic impacts, which are likely to deepen health inequalities in the long term. Over the coming months, the Health Foundation will continue to round up key evidence on COVID-19 and inequalities. In this article the Health Foundation give an overview of some key themes emerging from recent work on the unequal impact of COVID-19, focusing on how children and young people are being affected, and the economic effects of the pandemic. -
Content ArticleOne of many legal, ethical, and patient safety issues raised by the COVID-19 pandemic across the NHS is that expectant mothers are considering freebirthing more after home births are cancelled. The charity AIMS (Association for Improvements in the Maternity Services) states that while there is no specific definition of freebirthing, “…broadly speaking, a woman freebirths when she intentionally gives birth to her baby without a midwife or doctor present. Some women prefer to use the term ‘unassisted childbirth’ or UC to describe this.” This may carry major health risks. For example, if complications occur during a freebirth, professional clinical help will not be at hand to help. John Tingle explores this further in his blog for the Bill of Health. John Tingle is a regular contributor to the Bill of Health blog and is a Lecturer in Law at Birmingham Law School in the UK and a Visiting Professor of Law, Loyola University Chicago, School of Law.
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Content ArticleAfter the COVID-19 pandemic is over, a key issue remains for the UK’s NHS: Will there be less avoidable patient harm, fewer occurrences of “never events,” and fewer headline grabbing patient safety crises? John Tingle explores this further in his blog for the Bill of Health. John Tingle is a regular contributor to the Bill of Health blog and is a Lecturer in Law at Birmingham Law School in the UK and a Visiting Professor of Law, Loyola University Chicago, School of Law.
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Content ArticleHealth care law is evolving particularly rapidly during the COVID-19 pandemic. For example, as the COVID-19 pandemic continues, families in England who have lost loved ones to the virus are considering filing clinical negligence claims. Perhaps in part due to the general, heightened public awareness of rights to sue for clinical negligence, people in the UK are now considering taking legal action against the National Health Service (NHS) for improper, negligent COVID-19 treatment. In cases of clinical negligence during COVID-19, a key issue centers around whether medical practitioners followed relevant clinical guidelines. John Tingle explores this further in his blog for the Bill of Health. John Tingle is a regular contributor to the Bill of Health blog and is a Lecturer in Law at Birmingham Law School in the UK and a Visiting Professor of Law, Loyola University Chicago, School of Law.
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COVID Trauma Response Working Group
Patient Safety Learning posted an article in Good practice and useful resources
The COVID Trauma Response Working Group has been formed to help coordinate trauma-informed responses to the COVID outbreak. It is made up of psychological trauma specialists, coordinators of the psychosocial response to trauma, wellbeing leads at NHS Trusts and people with lived experience of psychological trauma. The working group is being coordinated by staff at University College London and the Traumatic Stress Clinic at Camden and Islington NHS Trust. On their website you will find many resources and information on the work they are doing. -
Content ArticleThe COVID-19 pandemic is emerging as the defining health crisis of our generation. Healthcare organisations were already a high-risk environment for workers, who are exposed on a daily basis to the suffering of their patients, tragedy, and the potential for failure. Now, healthcare staff of all kinds are straining to meet the demands of caring for patients with the novel coronavirus. Caring for patients with COVID-19 places them at personal risk for infection, and also poses a threat to their emotional well-being. If workers are not provided with sufficient emotional support, the distress can be disabling. It may render them less able to work to their full ability. This in turn can threaten the integrity of the health care workforce to deliver the volumes of care required by the pandemic. In the longer term individual workers are at risk for accelerated burnout, and for mental health problems like post traumatic stress disorder (PTSD). The Journal of Patient Safety and Risk Management asked their international editorial board to provide advice for healthcare leaders and managers and frontline clinicians for meeting the emotional needs of healthcare workers and supporting one another. They identified several priority areas central to maintaining and promoting the well-being of the workforce during the pandemic. These included meeting basic needs, improving crisis leadership and communication, promoting well-being, and providing mental and emotional support.
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Content ArticleFace coverings have become a flashpoint in the US, particularly now as COVID-19 cases continue to surge in Texas, Florida, and Arizona, among other states. Misinformation and mixed signals about masking have spread almost as quickly as the virus. And political debates pitting civil liberties vs. civic responsibilities have drowned out the growing body of evidence that shows wearing masks significantly reduce infection risk. Sonja Bartolome is a specialist in lung disorders and pulmonary disease, treating respiratory infections every day and has seen firsthand the aggressive nature in which they can spread. She lists the most common myths surrounding masks and separate them from the medical and scientific realities of the current situation.
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COVID-19 Recovery Collective
PatientSafetyLearning Team posted an article in Patient recovery
The COVID-19 Recovery Collective is a small team of collaborators that wanted to do something constructive to help those that are in recovery from the COVID-19 virus. The impact of the virus across the globe has been rapid and far reaching. Many are struggling to keep pace with developments, from the recovery process of the infection itself, to the economic consequences of the virus and also the sociological impact of lockdown.The collaboration started as a token action towards helping those that are in recovery from COVID-19, in the hope that by encouraging people to share their own experiences of recovery they can instil some reassurance in others of potential expectations. Through this sharing of experiences, we might see some similar patterns of recovery and also provide an opportunity to share any knowledge or actions that might have helped others to deal with the personal impact of the infection on their health. -
Content ArticleA framework designed by Dr Jane McCarthy, Human Factors and Patient Safety Consultant, for the measurement and monitoring of safety in the COVID-19 second wave.
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Content ArticleCOVID-19 is an unprecedented crisis which has had a profound impact on health and care services across the UK and will continue to have an impact for the months and years to come. To guide the restoration of services, 25 cancer charities have come together and developed this document to set out a ‘12-point plan’, supported by available data and intelligence, for what they believe the health service in England will need to do to enable cancer services to recover from the pandemic.
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Content ArticleThis document, developed by McMaster University's School of Rehabilitation Science in Canada, provides a guide for rehabilitation practice during the COVID-19 crisis. Informed by the best available evidence, including consultation with the clinical community, this living document consolidates findings from resources for front line rehabilitation professionals.
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Content ArticleSix years ago The Snowy White Peaks of the NHS highlighted the scale of race discrimination in the NHS, the UK’s biggest employer of Black and Minority Ethnic (BME) staff. COVID-19 has shown so much more needs to be done. 300 health and social care staff have died so far from COVID-19, a disproportionate number of BME heritage. We know NHS staff infection was overwhelmingly due to occupational exposure whose causes are varied but include the disproportionate BME staff role in patient-facing services, their poorer access to appropriate PPE, the greater reluctance of BME staff to raise concerns, disproportionate deployment into “hotter” roles, and the greater presence of BME colleagues amongst agency staff. BME staff have been largely absent from decision-making. The COVID-19 impact on BME staff, and Black Lives Matter, has prompted promises to tackle racism more resolutely. So what should NHS leaders do to ensure faster progress to tackle workforce race discrimination? Roger Kline, in this BMJ Leader blog, has ten suggestions for Boards and Integrated Care System system leaders.
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Content Article
How should surgeons obtain consent during the COVID-19 pandemic?
Patient Safety Learning posted an article in Blogs
Now that hospitals are resuming elective surgery, what should surgeons tell patients about the perioperative risks of COVID-19? Many surgeons are now resuming elective work, yet some make no mention of the additional covid-related risks. Although the British Association of Spine Surgeons and some private hospitals have produced information sheets for patients undergoing surgery during the pandemic, to our knowledge no formal guidance has been issued by the General Medical Council or the Royal College of Surgeons on obtaining consent in such circumstances. The surgical community remains unclear as to what to tell patients about to undergo elective surgery. In this BMJ Opinion article, Daniel Sokol and Rupen Dattani argue that patients who undergo elective surgery should be told that, despite measures to limit the risk of infection, there remains a risk of contracting covid-19 in hospital, whether before, during or after the operation.
