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Found 1,147 results
  1. News Article
    Senior clinicians say their trust board has caved into political pressure by making an ‘unsafe’ decision to re-open a small emergency department — having previously suggested this would not happen if there was a second wave of coronavirus. In a letter to management at Lancashire Teaching Hospitals Foundation Trust, seen by HSJ, a group of 17 emergency medicine consultants have raised serious concerns over the planned re-opening of the accident and emergency department at Chorley and South Ribble Hospital next week. The unit, which has long suffered from staffing shortages and temporary closures, was again closed on a temporary basis at the start of the coronavirus pandemic. When covid subsided in the summer, plans were put forward to reopen it in the autumn. However, when announcing this, chief executive Karen Partington said: “It is really important that everybody recognises that if covid-19 cases begin to rise significantly, or other safety concerns are identified, we will need to revisit the situation.” The letter from the clinicians, addressed to trust clinical director Graham Ellis, said: “We consider that the trust has been subjected to an undercurrent of external pressure which has resulted in an unsafe decision being taken to re-open the ED prematurely…" Read full story (paywalled) Source: HSJ, 30 October 2020
  2. News Article
    Hospital hotspots for COVID-19 have been highlighted in a new report by safety investigators. The report by the Healthcare Safety Investigation Branch (HSIB) makes a series of observations to help the health service reduce the spread of coronavirus in healthcare settings. Hospital hotspots for COVID-19 included the central nurses’ stations and areas where computers and medical notes were shared, the HSIB found. The investigation was initiated after a Sage report in May which found that 20% of hospital patients were reporting symptoms of Covid-19 seven days following admission – suggesting that their infection may have been acquired in hospital. In response to the report, NHS England and NHS Improvement confirmed they would publish nosocomial – another term for hospital acquired infections – transmission rates from trusts, the HSIB said. Read full story Source: Express and Star, 28 October 2020
  3. Content Article
    The report concludes with short, medium and long-term measures that support both immediate and future responses as the NHS continues to tackle the virus. The measures include eight national safety recommendations, safety observations and a tool that NHS trusts can use straight away to review their approach. Safety recommendations 1: It is recommended that the Department of Health and Social Care, working with NHS England and NHS Improvement, Public Health England, and other partners as appropriate, develops a transparent process to co-ordinate the development, dissemination and implementation of national guidance across the healthcare system to minimise the risk of nosocomial transmission of COVID-19. 2: It is recommended that NHS England and NHS Improvement supports additional capacity for testing for NHS patients and staff (Pillar 1 testing) facilitates the accessibility of rapid testing for NHS trusts, as soon as an increase in rapid testing supplies becomes available. 3: It is recommended that NHS England and NHS Improvement: develops a national intensive infection prevention and control (IPC) safety support programme for COVID-19 which focuses on leadership, IPC technical support, education, practice, guidance and assurance develops a national IPC strategy which focuses on developing IPC capacity, capability and sustainability across the NHS in England. 4: It is recommended that NHS England and NHS Improvement reviews the principles of the hierarchy of controls in its health building notes (HBN) and health technical memoranda (HTM) for the design of the built environment in existing and new hospital estate to reduce the risk of nosocomial transmission. 5: It is recommended that NHS England and NHS Improvement responds to emerging scientific evidence and shared learning when reviewing guidance for NHS trusts on the role of hospital ventilation systems in nosocomial transmission. 6: It is recommended that NHS England and NHS Improvement investigates and evaluates the risks associated with the potential impact of staff fatigue and emotional distress on nosocomial transmission of COVID-19. 7: It is recommended that the Department of Health and Social Care reviews and identifies the mechanisms which enabled regional and local organisations to adapt and respond with agility during the pandemic. This should inform the development of a strategic approach to national leadership models at times of crisis and under normal conditions. 8: It is recommended that NHSX considers how technology can assist in mitigating nosocomial transmission in the ward environment with regard to: the use of digital communication technologies in assisting with the deployment of staff and the dissemination and circulation of key information the increased use and availability of personal computing devices and electronic health record systems.
  4. News Article
    Ambulance chiefs have warned coronavirus precautions in hospital emergency departments are putting patients’ lives at risk because of long delays before patients are being treated. West Midlands Ambulance Service has written a formal warning to three hospitals in the region over the delays to handing over patients from ambulance to hospital staff. In one case, a patient was left waiting with ambulance crews for up to three and a half hours. According to the letter, obtained by the Health Service Journal, the delays are being caused because of tougher infection control measures with ambulance bosses warning the situation is “dangerous”. Director of nursing Mark Docherty said the delays meant ambulances could not be sent to “life threatening emergencies”, and warned: “Lives will be put at risk and patients will come to harm as a result”. He added: “I alerted you to a serious concern about patients being kept on ambulances outside your hospital. Of great concern is the fact that a hospital risk assessment identifies this process as a mitigation to reduce risk in your hospital…" Read full story Source: The Independent, 29 October 2020
  5. News Article
    The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy. During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis. The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies. As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease. There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus. Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met. Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home. There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites. Read full story Source: The Independent, 27 0ctober 2020
  6. News Article
    Cancer patients have had surgery cancelled because of coronavirus for the first time as pressure mounts on hospitals from the second wave, The Independent has learnt. Nottingham University Hospitals Trust has confirmed it had to postpone the operations because of the number of patients needing intensive care beds. While hospitals across the north of England have been forced to start cancelling routine operations in the last 10 days, maintaining cancer and emergency surgery had been a red line for bosses given the risk to patients from any delays. Cancer Research UK said it was “extremely concerning” that some operations had been postponed and called for urgent action and investment to make sure treatments were not curtailed further. In a statement to The Independent, Nottingham University Hospitals medical director Keith Girling said: “We’ve had to make the extremely difficult decision to postpone operations for four of our cancer/pre-cancer patients this week due to pressure on our intensive care units from both Covid-19 and non-covid related emergencies." “We expect to treat one of the postponed patients next week, and we’re in contact with the others to arrange a new date, which will be imminent. This delay, however short, will be incredibly hard for the patients and their families, and I’m truly sorry for any distress this will have caused. Read full story Source: The Independent, 27 October 2020
  7. News Article
    A GP commissioning leader has publicly criticised hospital visiting rules at local hospitals, after hearing that a stroke patient was denied seeing family or friends for six weeks. Philip Stevens, a locality chair at Northamptonshire Clinical Commissioning Group (CCG), described the situation reported to him by one of his patients as “heartbreaking”, and has challenged visiting policies at Northampton General Hospital and Kettering General Hospital trusts. During a CCG governing body meeting, Dr Stevens called for explanation from the county’s director of public health, Lucy Wightman, who said trusts could choose their own rules. Dr Stevens, who is also a GP at Brackley Medical Centre, argued that visitors were permitted in neighbouring counties, where he claimed there were similar covid case rates to Northamptonshire, which remains in tier 1 restrictions under the government’s framework. He said: “I’ve been dealing this week with a family who, the wife’s husband, has been in Northampton General for six weeks now and has had no visitors at all during that time. He’s had a profound stroke and when he comes home he’ll need considerable community support which ordinarily the family would have been trained in but discharge is planned without any of that training.” Mr Stevens said in an “adjacent county” hospital policy was that each patient would have ”one hour, one visitor each day” with 30-minutes in between visiting slots. While not named, trusts in neighbouring Cambridge and Lincolnshire both have policies that permit pre-booked visitors. He added: “When I heard this story it seemed heartbreaking to me for this woman and her husband and I just wonder whether that this is a situation we should be challenging, particularly since it appears that the public health advice in an adjacent county may be different to that which is being offered within Northamptonshire.” Read full story (paywalled) Source: HSJ, 27 October 2020
  8. News Article
    The first wave of COVID-19 may gave subsided in some areas of the United States, but in others it is growing and hospitals everywhere are continuing to face significant challenges. The American Hospital Association recently estimated that hospitals will incur at least $323.1 billion in losses through the end of this year due to COVID-19. Key contributors include postponed and cancelled elective procedures, lower patient volumes across all departments, and higher costs for supplies and devices. Other factors compound the financial challenges, including pressure for hospitals to implement new initiatives that foster a safer care environment for COVID-19 patients, non-COVID-19 patients, and healthcare providers. This pressure is mounting, as spikes in cases continue to appear in various regions, and as concerns grow about the flu season. The good news is that improving patient, staff, and visitor safety can actually help hospitals recover from the financial losses they are experiencing due to the pandemic. For example, enhanced patient safety leads to: Fewer costly events, such as hospital-acquired infections or conditions, acute kidney injuries, adverse drug events, readmissions, and return visits to the emergency department. Faster and more proactive identification of cost-saving opportunities, such as IV to PO conversions and more optimal management of high-cost drugs. Higher patient volumes due to a stronger quality and safety reputation. Hospitals face significant financial challenges, but they must also act quickly to ensure patient, staff, and visitor safety. Luckily, improving margins and enhancing patient safety don’t need to be competing priorities. When hospitals implement effective safety improvement approaches, margin improvements naturally follow. Read full story Source: MedCity News, 25 October 2020
  9. News Article
    NHS bosses have denied claims that thousands of frail elderly people were denied potentially life-saving care at the peak of the pandemic in order to stop the health service being overrun. NHS England took the unusual step on Sunday of issuing a 12-page rebuttal to allegations in the Sunday Times that patients deemed unlikely to survive were “written off” by being refused intensive care. Prof Stephen Powis, NHS England’s national medical director, said: “These untrue claims will be deeply offensive to NHS doctors, nurses, therapists and paramedics, who have together cared for more than 110,000 severely ill hospitalised Covid-19 patients during the first wave of the pandemic, as they continue to do today." “The Sunday Times’ assertions are simply not borne out by the facts. It was older patients who disproportionately received NHS care. Over two-thirds of our COVID-19 inpatients were aged over 65. “The NHS repeatedly instructed staff that no patient who could benefit from treatment should be denied it and, thanks to people following government guidance, even at the height of the pandemic there was no shortage of ventilators and intensive care.” The newspaper claimed the high coronavirus infection rate in the UK before lockdown began on 23 March and the NHS’s limited supply of mechanical ventilators going into the pandemic meant that “the government, the NHS and many doctors were forced into taking controversial decisions – choosing which lives to save, which patients to treat and who to prioritise – in order to protect hospitals”. The Sunday Times said its claims were the result of a three-month investigation that involved speaking to more than 50 sources in the NHS and the government about the health service’s response to the pandemic. Read full story Source: The Guardian, 25 October 2020
  10. News Article
    Concerns are growing that long NHS waiting times caused by the coronavirus crisis are exacerbating pre-existing health inequalities and creating a “two-tier” system, as more people turn to the private sector for quicker treatment. As leading doctors warn mass cancellations of NHS operations in England are inevitable this winter after waiting times reached the highest levels on record this summer, data shows a rise in the number of people self-funding treatment or investing in private health insurance. “COVID-19 has not impacted everyone equally, and there is clearly a risk that the backlog in routine hospital treatment is going to add to those inequalities if some people are able to get treatment faster because they’re able to pay,” said Tim Gardner, from the Health Foundation thinktank. As the NHS heads into winter and a growing second wave of the virus, experts stressed the need to help those affected by the backlog now. “There is a need to prioritise the most urgent cases, but simply because someone’s case isn’t urgent doesn’t mean it’s not important. It doesn’t mean that people aren’t waiting in pain and discomfort, or waiting anxiously for a diagnosis,” said Gardner. “We think it’s incumbent on the health service to make the best possible use of the capacity it’s got. But also it needs to make sure it’s supporting people while they’re waiting. We just can’t have people left in limbo.” Read full story Source: The Guardian, 27 October 2020
  11. News Article
    Almost half of hospital patients have been discharged without receiving the results of their coronavirus test – including some patients who were sent to care homes, new research from Healthwatch and British Cross has revealed. Independent national patient body Healthwatch England said it had learned many patients were discharged from hospitals between March and August this year without proper assessments with many vulnerable people sent home without medication, equipment or the care they needed. At the start of the pandemic thousands of patients were discharged to care homes as NHS England instructed hospitals to free up 15,000 beds ahead of the first wave of coronavirus. Approximately 25,000 patients were sent to care homes with some not tested, sparking fears this helped seed care homes with the virus. There have been around 16,000 care home deaths linked to COVID-19. According to a survey of almost 600 discharged patients and interviews with 60 NHS staff, Healthwatch England said it had found serious flaws with the way hospitals had followed NHS England’s instructions. Read full story Source: The Independent, 24 October 2020
  12. Content Article
    Key findings 82% of respondents did not receive a follow-up visit and assessment at home and almost one in five of these reported an unmet care need. Some people felt their discharge was rushed, with around one in five (19%) feeling unprepared to leave hospital. Over a third (35%) of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance. Overall patients and families were very positive about healthcare staff, praising their efforts during such a difficult time. Around a third (30%) of people faced an issue with delayed COVID-19 test results, potentially putting family and carers at risk, or in a care home, other residents and staff. Recommendations To help hospitals manage a second wave of COVID-19 hospital admissions ahead of winter, we have made several recommendations based on the experiences of people and staff, including: Post-discharge check-ins and assessments: Services should follow policy and ensure people are offered follow-up support soon after discharge, whether by phone or in person. Discharge checklists: Patients should be asked about the support they need, including any transport home and equipment required. Communication: Patients and carers should be given a single point of contact for further support or questions, in line with national policy. Medication: Waiting for medication can often lead to delays being discharged from hospital. Linking patients to voluntary sector partners or community pharmacists who can deliver medicine could avoid delays. Boost community care capacity and recognise the value of the voluntary care sector in hospital discharge: The current discharge policy depends on follow-up assessments and care being available. Longer-term, more investment is needed to ensure this happens, including in the voluntary care sector.
  13. News Article
    Levels of protective antibodies in people wane "quite rapidly" after coronavirus infection, say researchers. Antibodies are a key part of our immune defences and stop the virus from getting inside the body's cells. The Imperial College London team found the number of people testing positive for antibodies has fallen by 26% between June and September. They say immunity appears to be fading and there is a risk of catching the virus multiple times. More than 350,000 people in England have taken an antibody test as part of the REACT-2 study so far. In the first round of testing, at the end of June and the beginning of July, about 60 in 1,000 people had detectable antibodies. But in the latest set of tests, in September, only 44 per 1,000 people were positive. "Immunity is waning quite rapidly, we're only three months after our first [round of tests] and we're already showing a 26% decline in antibodies," said Prof Helen Ward, one of the researchers. The fall was greater in those over 65, compared with younger age groups, and in those without symptoms compared with those with full-blown COVID-19. The number of healthcare workers with antibodies remained relatively high, which the researchers suggest may be due to regular exposure to the virus. There have been very few confirmed cases of people getting Covid twice. However, the researchers warn this may be due to immunity only just starting to fade since the peak infection rates of March and April. The hope is the second infection will be milder than the first, even if immunity does decline, as the body should have an "immune memory" of the first encounter and know how to fight back. The researchers say their findings do not scupper hopes of a vaccine, which may prove more effective than a real infection. One of the researchers, Prof Graham Cooke, said: "The big picture is after the first wave, the great majority of the country didn't have evidence of protective immunity. The need for a vaccine is still very large, the data doesn't change that." Read full story Source: BBC News, 27 October 2020
  14. Content Article
    You may also be interested in the following content: Human factors resources (improving human performance in care delivery) Infectious diseases resources Coronavirus: Blogs
  15. News Article
    It has a plethora of symptoms, strikes the young and old, and lasts for months – maybe much longer. It’s also so new that scientists aren’t sure what they’re dealing with. For those whose lives have been deeply affected by long-term repercussions of Covid, the battle to be recognised is just the start. There are thousands of people in the UK dealing with the long-term effects of COVID-19, experiencing debilitating symptoms that last for weeks and months beyond the initial infection. One of the most commonly reported is fatigue, along with breathlessness, joint pain and muscle aches. Neurological issues are common, particularly brain ‘fog’ and a loss of memory and concentration. Some have chest pain or heart palpitations, skin rashes, diarrhoea, headaches, hearing or eyesight problems, or hair loss. Others have lost their senses of taste and smell. In online support groups, people are sharing stories of bone-crippling exhaustion, constant pain in their chest or heart, or the inability to remember a name or follow a conversation. These people don’t fit the binary model of the virus we thought we knew – that if you’re in the small minority who are seriously affected you might be hospitalised, end up in ICU or worse; otherwise you’ll likely be better after two weeks. Many only had mild cases originally and were not deemed to be in vulnerable categories. Widely varying symptoms have added to the confusion and fear surrounding the condition, which currently has no formal definition. For months, people with Long Covid had no one to turn to but each other. It’s only recently – through increasing research emerging, and sufferers publicly sharing their stories – that it has started to be taken more seriously. Earlier this month, NHS England announced a £10 million investment to set up one-stop services for physical and mental health issues caused by Covid alongside a Long Covid task force and, crucially, research on 10,000 patients. Not much is known about what causes Long Covid and there is little firm consensus. There are theories it occurs when a patient’s immune system overreacts to the infection, which can lead to widespread inflammation that theoretically affects any organ. Last week, a study by the National Institute for Health Research (NIHR) suggested Long Covid symptoms could actually be caused by four separate syndromes: post-intensive-care syndrome, post-viral fatigue syndrome, permanent organ damage to the lungs and heart, or lingering COVID-19 symptoms. Read full story Source: The Telegraph, 24 October 2020
  16. News Article
    n the day Boris Johnson was admitted to hospital with COVID-19, Vivien Morrison received a phone call from a doctor at East Surrey Hospital in Redhill. Stricken by the virus, her father, Raymond Austin, had taken a decisive turn for the worse. The spritely grandfather, who still worked as a computer analyst at the age of 82, was not expected to survive the day. His oxygen levels had fallen to 70% rather than the normally healthy levels of at least 94%. Vivien says she was told by the doctor that her father would not be given intensive care treatment or mechanical ventilation because he “ticked too many boxes” under the guidelines the hospital was using. While ministers delayed lockdown, soaring cases were putting immense pressure on hospitals. This investigation from The Times shows officials devised a brutal ‘triage tool’ to keep the elderly and frail away. Read full story (paywalled) Source: The Sunday Times, 25 October 2020)
  17. News Article
    "I still have nightmares most nights about being completely out of my depth." Gemma, a ward nurse in Northern Ireland, was redeployed to a critical care unit at the end of March when the first wave of coronavirus struck. "I had never looked after a critically ill intensive care patient in my life," she says. "I just thought, I'm coming in here and I'm going to die. I'm going to catch Covid and I'm going to be one of those patients in the beds." As the second wave of the pandemic takes deep root across parts of the UK, thousands of NHS workers are struggling to recover from what they have already been through. "We were all in PPE all the time," recalls Nathan, a senior intensive care nurse at a hospital in the Midlands. "All you can see is people's eyes, you can't see anything else." He describes trying to help junior members of staff survive long and difficult days. "And I'd see these eyes as big as saucers saying help me, do something. Make this right. Fix this." "The pressure was insane, and the anxiety just got me," he says. "I couldn't sleep, and I couldn't eat, I was sick before work, I was shaking before I got into my car in the morning." Nathan ended up having time off with severe anxiety, but he is now back at the hospital, waiting for the beds to fill up again. The BBC has spoken to a number of nurses and doctors across the UK who are deeply apprehensive about what lies ahead this winter. Read full story Source: BBC News, 24 October 2020
  18. News Article
    Women aged 50-60 are at greatest risk of developing “long Covid”, analysis suggests. Older age and experiencing five or more symptoms within the first week of illness were also associated with a heightened risk of lasting health problems. The study, led by Dr Claire Steves and Prof Tim Spector at King’s College London, analysed data from 4,182 COVID Symptom Study app users who had been consistently logging their health and had tested positive for the virus. In general, women were twice as likely to suffer from Covid symptoms that lasted longer than a month, compared with men – but only until around the age of 60, when their risk level became more similar. Covid vaccine tracker: when will a cor Increasing age was also associated with a heightened risk of long Covid, with about 22% of people aged over 70 suffering for four weeks or more, compared with 10% of people aged between 18 and 49. For women in the 50-60 age bracket, these two risk factors appeared to combine: They were eight times more likely to experience lasting symptoms of Covid-19 compared with 18- to 30-year-olds. However, the greatest difference between men and women was seen among those aged between 40 and 50, where women’s risk of developing long Covid was double that of men’s. “This is a similar pattern to what you see in autoimmune diseases,” said Spector. “Things like rheumatoid arthritis, thyroid disease and lupus are two to three times more common in women until just before menopause, and then it becomes more similar.” His guess is that gender differences in the way the immune system responds to coronavirus may account for this difference." Read full story Source: The Guardian, 21 September 2020
  19. News Article
    A trust is investigating after two junior doctors developed covid following an offsite event attended by 22 juniors where social distancing rules were allegedly ignored. The cases, involving doctors from the Royal Surrey Foundation Trust in Guildford, have been declared an outbreak by Public Health England and police have investigated the incident. But HSJ understands that contact tracing has concluded no patients needed to be tested because staff had worn appropriate PPE at all times and those involved had swiftly self-isolated once they realised they might have covid or had been at risk of exposure to it. It is not known whether any of the doctors had returned to work after the event before realising they might have been exposed to covid. Dr Mark Evans, deputy medical director, said: “Protecting our patients is our priority and we are committed to ensuring that all of our staff follow government guidance. This incident took place outside of work and has been reported appropriately, and there was no disruption to our services for patients.” Read full story Source: HSJ, 22 October 2020
  20. News Article
    Mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said. Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped. "Things are very, very difficult at the moment, very challenging at the moment. It feels like a juggling act every day,” said one official in the South Yorkshire NHS. “The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating.” Read full story Source: The Guardian, 23 October 2020
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