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Found 416 results
  1. Content Article
    The total value of clinical claims associated with emergency medicine was nearly £700m in 2022/23, making them the second highest total value of claims by speciality. This podcast focuses on clinical negligence claims from the emergency department, and how insights from claims data can be used by emergency medicine teams to help improve safety. Hosted by Justine Sharpe from NHS Resolution's Safety and Learning team, the episode features guests from NHS England’s Getting It Right First Time team and the Royal College of Emergency Medicine. Topics covered include: The key themes and recommendations from NHS Resolution's 2022 ED reports, including discussion of cauda equina and aortic dissection How to use local claims data from NHSR and operational performance data from GIRFT to inform safer patient care Insights into specialty reviews and handover, communication and the importance of multidisciplinary ED teams.
  2. News Article
    NHS England has confirmed new financial incentives for trusts to deliver strong performance against the four-hour emergency target this month. National leaders are desperate for the NHS to hit the four-hour target in 76% of cases in March, telling trusts earlier this month that it was necessary to restore confidence in the health service. They took the unusual step at the start of the month of asking local leaders to sign a commitment to deliver the necessary performance. The recent pressure has come under criticism for encouraging hospitals to prioritise four-hour performance over caring for the sickest patients. It was also indicated there would be new financial incentives for those delivering the best performance. In a letter, NHSE confirmed a significant expansion to the criteria for trusts to claim a share of a £150m incentive fund, by improving their headline accident and emergency performance. Read full story (paywalled) Source: HSJ, 12 March 2024
  3. News Article
    More than 7,300 people waited longer than 24 hours for emergency treatment in Scottish hospitals last year, with the longest wait more than 122 hours. Public Health Scotland statistics obtained by Scottish Labour through freedom of information (FoI) revealed that 7,367 patients were in an emergency department for more than 24 hours before being discharged, admitted or transferred in 2023. The longest wait in A&E last year occurred at NHS Ayrshire and Arran’s University Hospital Crosshouse, where a patient waited more than 122 hours, or the equivalent of five days. Waits of more than 88 hours were recorded in NHS Borders, and 72 hours in NHS Lanarkshire. Dame Jackie Baillie, Scottish Labour’s health spokeswoman, has demanded action from Neil Gray, the health secretary. “Scotland’s A&E departments are in the grip of a deadly crisis, with lives being put on the line day in and day out,” she said. “That some people have waited days — even a working week — to be seen is dangerous and disgraceful. “Hard-pressed A&E staff are working tirelessly to look after patients, but SNP mismanagement has created a perfect storm in our hospitals. Neil Gray has inherited an NHS in deadly disarray from his colleagues. “It’s time for action to be taken now to bolster A&E departments by tackling delayed discharges and investing in primary care to avoid putting further pressure on hospital services.” Read full story (paywalled) Source: The Times, 11 March 2024
  4. News Article
    Distressed elderly patients are being “treated like animals” and left begging for care as NHS staff struggle to cope with overwhelmed wards and an ever-increasing ageing population, an investigation by The Independent has revealed. Scores of families have come forward to share harrowing allegations of neglect as one top doctor warns that elderly people are receiving care “well below the standards they should expect” – including long waits in waiting rooms and “degrading” corridor care. In one shocking case, a 96-year-old patient admitted to the hospital with a urinary tract infection (UTI) was allegedly left semi-naked and delirious in his hospital bed – before choking on vomit after being sedated without his family’s permission, his daughter told The Independent. Another patient, 99, was traumatised after being left in a bed next to the body of a dead woman. The investigation was sparked by the horrific story of 73 year old Martin Wild who was left so desperate for pain medication he was forced to call 999 from his hospital bed. It comes as analysis by the Independent shows the government was warned three times last year by coroners over the increasing risk to elderly patients’ lives amid fears they are not being “effectively safeguarded”. Read full story Source: The Independent, 11 March 2024
  5. News Article
    Long A&E waits have got worse at more than one in five acute trusts, despite an improving trend nationally. Around 30 acute trusts have reported an increase in long accident and emergency waits, bucking the national trend. According to data covering the nine months to December, the proportion of waits more than 12 hours from time of arrival has improved to 6.3%, down from 8% during the same period in 2022. However, 28 out of 119 acute trusts reported a rise of up to 3 percentage points. HSJ’s analysis, which used published and unpublished data, showed 11 of these trusts had worsened despite improving their headline performance against the four-hour target. Adrian Boyle, of the Royal College of Emergency Medicine, said the emphasis on the four-hour target “incentivises focus on the people who are being sent home, and takes effort and attention away from the people who are being admitted to hospital”. He added: “The harms of long waits are greatest for people being admitted to hospital. We are disappointed by the current lack of focus in the planning guidance to help our most vulnerable patients.” Read full story (paywalled) Source: HSJ, 27 February 2024
  6. News Article
    A newly installed electronic patient record contributed to the “preventable” death of a 31-year-old woman in an emergency department, a trust has been warned. Emily Harkleroad died at University Hospital of North Durham in December 2022 following “failures to provide [her] with appropriate and timely treatment” for a pulmonary embolism, a coroner has said. The inquest into her death heard emergency clinicians had raised concerns about a newly installed electronic patient record, provided by Oracle Cerner, which they said did not have an escalation function which could clearly and quickly identify the most critical patients. The inquest heard the new EPR, installed in October 2022, did not have a “RAG rating” system in which information on patient acuity “was easily identifiable by looking at a single page on a display screen” – as was the case with the previous IT system. The software instead relied on symbols next to patients’ names which indicate their level of acuity when clicked on, but did “not [provide] a clear indication at first glance” of their level of acuity. Rebecca Sutton, assistant coroner for County Durham and Darlington, said that “errors and delays” meant Ms Harkleroad did not receive the anticoagulant treatment that she needed and “which would, on a balance of probabilities, have prevented her death”. “It is my view that, especially in times of extreme pressure on the emergency department, a quick and clear way of identifying the most critically ill patients is an important tool that could prevent future deaths.” Read full story (paywalled) Source: HSJ, 23 February 2024
  7. Content Article
    On 18 December 2022, Emily Harkleroad collapsed when out with a friend. She was taken by ambulance to the University Hospital of North Durham Emergency Department. Despite staff recognising that pulmonary embolism was the likely diagnosis, there were failures to provide Emily with appropriate and timely treatment for pulmonary embolism. Errors and delays in the Emily’s medical treatment resulted in her not receiving the anticoagulant treatment that she needed, and which would, on a balance of probabilities, have prevented her death. She died as a result of pulmonary embolism in the early hours of 19 December 2022 at the University Hospital of North Durham.
  8. Content Article
    Corridor nursing is increasingly being used in the NHS as demand for emergency care grows and A&E departments struggle with patient numbers. In this anonymous account, a nurse shares their experience of corridor nursing, highlighting that corridor settings lack essential infrastructure and pose many safety risks for patients. They also outline the practical difficulties providing corridor care causes for staff, as well as the potential for moral injury.  Using the System Engineering Initiative for Patient Safety (SEIPS) framework, they describe the work system, the processes and how that influences the outcomes.
  9. News Article
    Another inquiry has been launched into the sudden death of a second teenage girl in the Accident and Emergency department of University Hospital Limerick three weeks ago. The 16-year-old girl died suddenly on January 29, hours after she was rushed to UHL suffering from breathing difficulties. The girl, a much-loved only child, died in front of her mother in what an informed source described as “deeply traumatic circumstances”. It is the latest tragedy under review at UHL following the death of Aoife Johnston (16) from Shannon, Co Clare, Read full story Source: Irish Independent, 20 February 2024
  10. News Article
    The number of patients waiting more than 12 hours for a bed on a ward after being seen in A&E in England was 19 times higher this winter than it was before the pandemic, figures show. There were nearly 100,000 12-hour waits in December and January - compared with slightly more than 5,000 in 2019-20. A decade ago these waits were virtually unheard of - in the four winters up to 2013-14 there were fewer than 100. The King's Fund said long delays were at risk of becoming normalised. It said the pressures this winter had received little attention compared with last winter, despite no significant improvement in performance. During December 2023 and January 2024, 98,300 patients waited more than 12 hours for a bed on a ward after A&E doctors took the decision to admit them. The Northern Ireland branch of the Royal College of Emergency Medicine (RCEM) said the pressures were "unsurmountable" and it was having a detrimental impact on patients. Read full story Source: BBC News, 15 February 2024
  11. News Article
    An investigation has been launched after a woman died days after being found unconscious underneath her coat while waiting in A&E for seven hours. The 39-year-old woman is understood to have first attended A&E at Queen’s Medical Centre in Nottingham on the evening of 19 January complaining of a severe headache. She was triaged and then observed by nurses three times. Her case was escalated but she was not seen by a doctor before being discovered. When the woman was called to see a doctor, she did not respond. It was assumed that she had left A&E because she had waited so long. She was discovered and transferred to intensive care but died three days later on 22 January. A source familiar with the hospital told LBC, which first reported the incident, that the A&E department could have up to 80 patients waiting at a single time and that wait times could be as long as 14 hours. Dr Keith Girling, the medical director at Nottingham university hospitals NHS trust, said: “I offer my sincere condolences to the family at this difficult time. An investigation, which will involve the family, will now take place and until this has been concluded, we are unable to comment further.” Read full story Source: The Guardian, 10 February 2024
  12. News Article
    The number of patients waiting more than 12 hours in A&E hit a record in January of almost 180,000 people. Worsening pressures on A&E come as prime minister Rishi Sunak has officially missed his pledge, made in January last year, to cut the NHS waiting list. NHS England began publishing previously-hidden data on patients waiting 12 hours or more last year, after reports by The Independent. The latest figures for January show 178,000 people were waiting this long to be seen, treated or discharged after arriving from A&E – a record since February 2023 when the data was first published. In that month, 128,580 people waited more than 12 hours, and in December there were 156,000. The number waiting at least four hours from the decision to admit to actual admission has also risen, from 148,282 in December to 158,721 last month – the second-highest figure on record. Dr Tim Cooksley, past president of the Society for Acute Medicine, warned: “Degrading corridor care and prolonged waits causing significant harm is tragically and increasingly the expected state in urgent and emergency care.” Read full story Source: The Independent, 8 February 2024
  13. Content Article
    Set up in January 2023, the Times Health Commission was a year-long projected established to consider the future of health and social care in England in the light of the pandemic, the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population. Its recommendations are intended to be pragmatic, practical, deliverable and able to be potentially taken up by any political party or government, present or future. 
  14. Content Article
    Expecting paramedics to wade through shared care records is unsafe and inefficient. In an emergency, access to essential information has to be easy and fast, writes Claire Jones from NHS England South West. Whilst ambulance services may need access to the entire longitudinal record, it is imperative that in those first vital minutes of an emergency they have the most pertinent and relevant data at their fingertips. In such cases, information sharing can be a matter of life or death. We should make it as easy as possible for emergency care providers to access and view relevant information about the person in their care.
  15. News Article
    Paramedics are "watching their patients die in the back of ambulances because they can't get them into A&E", according to the health union, Unison. It was commenting on data showing 2,750 hours were lost by ambulance crews waiting to hand over patients at Hull Royal Infirmary in October 2023. One crew was stuck outside A&E for 10 hours and 27 minutes. Hull University Teaching Hospitals said it was "confident" a new urgent treatment centre on the hospital site would "improve overall waiting times" and lost ambulance hours had "reduced notably" this month. The figures, obtained by the BBC through a freedom of information request, showed on 9 October 2023 ambulance crews lost 144 hours and 18 minutes, the equivalent to one crew being out of action for six full days and nights. Megan Ollerhead, Unison's ambulance lead in Yorkshire, said paramedics were "literally watching their patients die in the back of these ambulances because they can't get into A and E." "I talk to a lot of the people who receive the 999 calls in the control rooms and they're just listening to people begging for ambulances and they know there are none to send." Read full story Source: BBC News, 26 January 2024
  16. Content Article
    On the 9 December 2022, Dennis John William King suffered sudden chest pain which extended down his arm. His wife called 999 and spoke with an ambulance service call handler. Following triage of the call, the response to Mr King's call was graded as a Category 3 (a potentially urgent condition which is not life threatening with a target response of 120 minutes). This call was subsequently re-graded following review in the call centre to a Category 2 (a potentially serious condition requiring rapid assessment, urgent on scene intervention or transport to hospital, with a response within 40 minutes and a target of 18 minutes).   Upon hearing that the waiting time for an ambulance could be as long as six hour, Mr and Mrs King decided to make their own way to the West Suffolk Hospital. The ambulance service were advised and the response stood down.   Within 40 minutes of arrival Mr King had been diagnosed as suffering an ST segment elevation myocardial infarction (STEMI). Treating clinicians assessed his condition as necessitating an urgent transfer to the Royal Papworth and for the angioplasty procedure to be conducted forthwith. The ambulance call centre was contacted by the hospital emergency department with a request for an urgent transfer to the Royal Papworth. Emergency department staff were advised that there would be a 5 hour delay for an ambulance to attend. The call from the hospital emergency department to the ambulance service was graded by the ambulance call handler as a category 2 response. When the response timing was challenged the emergency department matron was advised that the hospital was a place of safety. The ambulance call handler assessment did not seem to take into account the clinical assessment of accident and emergency department staff who, in consultation with the regional cardiac intervention hospital, had determined Mr King's further treatment at the regional cardiac centre was a matter of urgency. An ambulance subsequently arrived at West Suffolk Hospital Accident and Emergency Department and transferred Mr King to the Royal Papworth Hospital where he underwent treatment for what was identified as an occluded left anterior descending artery. About 1 hour after the procedure, Mr King's condition deteriorated and he suffered a left ventricular wall rupture, a recognised complication of either the myocardial infarction he had suffered or the surgical procedure to correct the occluded artery, or both. He received emergency surgery to repair the rupture by way of a patch which was successful. However, his condition deteriorated and he died on the 13 December 2022. The medical cause of death was confirmed as: 1a Multi Organ Failure 1b Post myocardial infarction left ventricular free wall rupture (operated on).
  17. News Article
    Patients have suffered cardiac arrests while waiting in A&E departments or in ambulances queueing outside because Scottish hospitals are overwhelmed, doctors have warned. At least three cases in which patients’ hearts stopped beating while they were waiting for care have been reported to the Royal College of Emergency Medicine in Scotland. Some of the incidents, the college said, may have been preventable. One frontline doctor told The Times that a patient with heart problems had died waiting in a queue of ambulances outside an emergency department. Staff could not take the patient inside because there was no capacity. JP Loughrey, vice-president of the college and an A&E consultant in the west of Scotland, said that people who should be in resuscitation rooms with a team of experts and equipment to monitor their vital signs were instead lying in ambulances outside hospital buildings. He also said that tensions were growing between frontline staff and NHS managers in large hospitals because doctors and nurses, who were already struggling to cope, were under increasing demands to work harder to process more patients. Read full story Source: The Times, 19 January 2024
  18. News Article
    A record 420,000 patients had to wait more than 12 hours in A&E last year, analysis has shown. The latest NHS England figures revealed a 20% increase on 2022 in people facing lengthy delays after a decision to admit them to hospital from the emergency department. In 2023, 419,560 people – or one in 15 A&E patients – faced “trolley waits” of 12 hours or more, according to the Liberal Democrats, who compiled the analysis. It marks by far the highest number since records began in 2011, and amounts to an average of 1,150 patients a day. Ed Davey, the party leader, criticised the “appalling delays” and accused Rishi Sunak’s government of “ignoring the suffering of patients and driving our health service into the ground”. Significant waits in A&E have been linked to excess deaths and increased harm to patients, as their condition could deteriorate before they are admitted or given a bed on a ward. Davey said: “Every year A&E delays are getting worse and worse under this Conservative government as hospitals are starved of the resources and staff they need. These appalling delays are leaving often vulnerable and elderly patients waiting for hours on end in overcrowded A&Es." Read full story Source: The Guardian, 14 January 2024
  19. News Article
    NHS England and government are set to raise their target for four-hour A&E performance, despite most hospitals failing to meet the current ask. HSJ understands officials are likely to use 2024-25 planning guidance to raise the “interim” target for four-hour performance from the 76% which trusts were asked to hit in 2023-24. A new objective of 80% by March 2025 has been discussed, several sources said, but is not confirmed. The 76% target has not been met during any month of 2023-24 so far, and most acute trusts are consistently falling well short of it. Well-placed sources told HSJ the target was likely to be increased despite “some doubts” among senior NHSE officials. One senior NHSE source said: “The target should be increasing incrementally as overall NHS A&E performance improves, [but] it hasn’t really improved this year.” Read full story (paywalled) Source: HSJ, 5 January 2024
  20. News Article
    The Welsh Ambulance Service is struggling to cope as many A&E departments are full and some patients have reportedly been waiting to be offloaded from ambulances for as long as 15 hours. The service has issued a plea for the public to "use 999 responsibly" amid severe pressure. An employee of the service said: "Nearly every A&E department is at capacity. Patients have been on ambulances for the last 15 hours. The ambulance service is only responding to red [immediately life-threatening] calls." The service has received almost 13,000 calls to 999 since Boxing Day and there have been almost 36,000 calls to the NHS 111 Wales service. Lee Brooks, the ambulance service’s operations boss, said: “Pent-up demand from the Christmas and New Year period, coupled with the seasonal illnesses we see at this time of year, means there are lots of people across Wales trying to access health services currently. When hospitals are at full capacity, it means ambulances can’t admit their patients, and while they’re tied up at emergency departments, other patients in the community are waiting a long time for our help, especially if their condition isn’t life-threatening. “We’re working really hard as a system to deliver the best possible care to patients, but our ask of the public today – and in the coming days – is only to call 999 if they are seriously ill or injured, or where there is an immediate threat to someone’s life. That’s people who’ve stopped breathing, people with chest pain or breathing difficulties, loss of consciousness, choking, severe allergic reactions, catastrophic bleeding or someone who is having a stroke." Read full story Source: Wales Online, 3 January 2024
  21. Content Article
    NHS hierarchies and paternalistic cultures can mean patients’ and families’ concerns are dismissed or undermined—but challenging them can be lifesaving. In this opinion piece for the BMJ, Zosia Kmietowicz shares the story of her son's experience at A&E, when a nurse intervened to question a doctor's treatment plan to ensure he received antibiotics for meningitis. She highlights the need for a system that allows staff to intervene when they are concerned, regardless of their status or position in the system.
  22. News Article
    Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays. In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”. The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls. The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working. “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.” Read full story (paywalled) Source: HSJ, 11 December 2023
  23. News Article
    Patients needing emergency treatment are becoming sicker in A&E as hospitals struggle to free up enough beds, top doctors have warned. Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), told The Independent that elderly patients are waiting so long for treatment in A&E that they’re developing bed sores and delirium. Another senior NHS doctor, Dr Vicky Price, who is president-elect of the Society for Acute Medicine, warned that corridor care is now “routine practice” with the situation only set to worsen as A&E departments come under increasing pressure. Their comments highlight the ongoing chaos in emergency medicine, as strikes take place during the most difficult time of the year. The chief executive of the NHS, Amanda Pritchard, said on Thursday that last winter was the worst she’d ever seen for the health service, warning that strikes by junior doctors will only make the situation harder for hospitals this year The warnings come as the latest NHS data shows that the prime minister, Rishi Sunak, could fail in his promise to deliver 5,000 more acute hospital beds to the NHS this month. Current data shows that the NHS is falling short of the target by just under 1,200 beds, with 97,818 against a target of 99,000. Read full story Source: The Independent, 10 November 2023
  24. News Article
    Almost 8,000 people were harmed and 112 died last year as a direct result of enduring long waits for an ambulance or surgery, prompting warnings that NHS care delays are “a disaster”. The fatalities included a man who died of a cardiac arrest after waiting 18 minutes for his 999 call to be answered by the ambulance service and was dead by the time the crew arrived. The figures are the first time NHS England has disclosed how often doctors and nurses file a patient safety report after someone suffers harm while waiting for help. They show that patient deaths arising directly from care delays have risen more than fivefold over the last three years, from 21 in 2019 to 112 last year, as the NHS has come under huge strain. The number of people who came to “severe harm” has also jumped from 96 to 152 during that period. “These data are alarming and show quite clearly the human impact the crisis in the NHS is having on individual patients,” said Rachel Power, the chief executive of the Patients Association. “We have been watching a disaster unfolding across the NHS and have repeatedly warned about the threat to patient safety because of it.” Read full story Source: The Guardian, 27 November 2023
  25. News Article
    Several trusts are failing to admit their sickest emergency patients in a timely fashion, despite performing well in official waiting time statistics, HSJ can reveal. The internal NHS England data, obtained via a Freedom of Information request, reveals 12 trusts which have performed above the average against the four-hour accident and emergency target are delivering relatively poor waiting times for patients who require admission, as opposed to those who, for example, can be discharged after being seen. The unpublished provisional data shows an average of just 30% of admitted patients in England spend four hours or less in A&E against the 95% target. But many trusts are falling significantly below this – including those trusts at or around NHSE’s interim target of 76% for four hours performance for all patients by March 2024. Read full story (paywalled) Source: HSJ, 24 November 2023
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