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Found 63 results
  1. Content Article
    HSJ revealed this month that the ’call before you walk’ model is being trialed in London, Portsmouth and Cornwall, with system leaders keen for a wider roll-out ahead of winter. In these trials, which have received the backing of the Royal College of Emergency Medicine, NHS 111 is being used as a “triage point” enabling patients needing urgent treatment, but not facing medical emergencies, to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists. Emergency patients just walking in, or those arriving via ambulance, will be treated, in theory, as per the current system. Similar models are used in Denmark, Norway and the Netherlands where they have high approval ratings. But these are vastly different healthcare systems with better resourced out of hospital services. So, can the model work in the English NHS? It is critical to view efforts to introduce ‘call before you walk’ in the wider policy context. The move is part of a far wider radical overhaul of emergency care pathways broadly designed to address the dangerous overcrowding seen in EDs in recent years.
  2. News Article
    Trials of new systems to prevent overcrowding in emergency departments ahead of a potential second wave of COVID-19 in the winter are taking place at hospitals in Portsmouth and Cornwall and are due to shortly be expanded to other areas, with Dorset and Newcastle likely sites, HSJ can reveal. London is also experimenting with introducing the system, having pulled back from an earlier proposal to roll it out it rapidly, shortly after the COVID-19 peak. In the trials, NHS 111 has acted as a “triage point” enabling patients not facing medical emergencies but needing urgent treatment to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists. Patients are discouraged from attending without an appointment, but they are able to do so; and sources said performance targets would continue to apply to them, although these were already subject to review pre-covid. Both the Royal College of Emergency Medicine and NHSE are now hopeful a new triage system for emergency care can be in place by the winter. Read full story (paywalled) Source: 15 July 2020
  3. News Article
    People with non-life threatening illnesses will be told to call before going to Wales' biggest A&E department. Patients will be assessed remotely and given a time slot for the University Hospital of Wales in Cardiff if needed. Hospital bosses feel returning to over-crowded waiting rooms would provide an "unacceptable" risk to patients due to coronavirus. The system is set to start at the end of July, but will not apply to people with serious illnesses or injuries. Details are still being discussed by Cardiff and Vale health board, but patients with less serious illnesses or injuries will be told to phone ahead, most likely on the 24-hour number used to contact the local GP out-of-hours service. They will be assessed by a doctor or a nurse and, depending on the severity of the condition, will either be given a time window to go to A&E or be directed to other services. This system was introduced in Denmark several years ago. "This is all about being safe and ensuring that emergency medicine and emergency care is safe and not about putting barriers in place to those more vulnerable people," says the department's lead-doctor Dr Katja Empson. "What we really think is that by using this system, we'll be able to focus our attention on those vulnerable groups when they do present." If successful, the system could become a long-term answer to reducing pressures on emergency medicine, she added. Read full story Source: BBC News, 14 July 2020
  4. News Article
    Far fewer people are having surgery or cancer treatment because COVID-19 has disrupted NHS services so dramatically, and those who do are facing the longest waits on record. NHS figures reveal huge falls in the number of patients who have been going into hospital for a range of vital care in England since the pandemic began in March, prompting fears that their health will have worsened because diseases and conditions went untreated. Patients have been unable to access a wide range of normal care since non-COVID-19 services were suspended in hospitals in March so the NHS could focus on treating the disease. Many patients were also afraid to go into hospital in case they became infected, which contributed to a fall in treatment volumes. Tim Gardner, a senior policy fellow at the Health Foundation thinktank, said: “The dramatic falls in people visiting A&E, urgent referrals for suspected cancer and routine hospital procedures during lockdown are all growing evidence that more people are going without the care they need for serious health conditions." “Early diagnosis and prompt treatment of cancer is crucial to saving lives, and delays in referrals and treatment during the pandemic are likely to mean more people are diagnosed later when their illness is further advanced and harder to treat.” Read full story Source: Guardian, 9 July 2020
  5. News Article
    Delays in going to the emergency department because of the coronavirus pandemic lockdown may have been a contributory factor in the deaths of nine children, a snapshot survey of consultant paediatricians in the UK and Ireland has shown. Three of the reported deaths associated with delayed presentation were due to sepsis, three were due to a new diagnosis of malignancy, in two the cause was not reported, and one was a new diagnosis of metabolic disease. Read full story (paywalled) Source: BMJ, 30 June 2020
  6. News Article
    The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe. Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues. “If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year. "We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.” He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”. Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May. Read full story Source: The Independent, 17 June 2020
  7. News Article
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls". Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that." Read full story (paywalled) Source: The Telegraph, 16 June 2020
  8. News Article
    Emergency attendances for several conditions are still well below their normal levels, despite a steady increase in overall activity since the peak of the coronavirus outbreak. Weekly data from Public Health England suggests overall A&E attendances increased to around 105,000 in the last week of May, which was an increase from 98,813 over the previous seven days. Data from the 77 A&E departments included in the research suggests that overall attendances are up to an average of 15,000 day, compared to around 10,000 at the peak of the pandemic and the long-term trend of just under 20,000. However, attendances for bronchitis, acute respiratory infections, respiratory, pneumonia, asthma, gastroenteritis are still far below their normal levels. It did not offer an explanation for why attendances for these conditions have remained low, while those for cardiac, influenza, myocardial Ischaemia, and gastrointestinal problems have returned to normal levels or above. Read full story Source: HSJ, 5 June 2020
  9. News Article
    An emergency unit at a Norwich hospital has reduced ward admissions and is helping shield urgent non-COVID-19 patients. The older people’s emergency department (Oped) – a special unit at the Norfolk and Norwich university hospital – is providing emergency care for patients over 80. Launched in 2017, the unit, just down the corridor from A&E, has six beds, two in side rooms and no waiting room. Normally, it admits patients identified as frail and usually with multiple conditions that need a lot of care (such as cognitive impairment, incontinence or reduced mobility). They are brought straight in by ambulance or trolley from other parts of the hospital and seen by a consultant geriatrician within two hours. A team of nurses with experience in both emergency care and care of the elderly, pharmacists and physiotherapists are on hand to support patients much more quickly than A&E to get patients out of hospital and back home within the same day wherever possible. For patients who need to stay longer after treatment there is an adjacent ambulatory ward. This unique model is showing results. The proportion of the specialist department’s patients admitted to the hospital is 50% compared with 68% for the same age group of emergency patients coming to the hospital five years ago, when they were treated at the normal A&E. When Oped patients are admitted, their average length of stay is 1.2 days less. “It’s just what we want for old people,” says Dr Sarah Bailey, the department’s lead consultant geriatrician. “We get the experts in straight away because we recognised that’s the best thing for [them]”. During the pandemic, the unit is helping to keep those who do not have coronavirus symptoms, such as those with injuries from falls and some stroke patients, away from the main A&E ward, providing a degree of shielding not normally possible. But for most NHS trusts, providing a separate unit like Oped is not feasible. “Hospitals are working to separate emergency patients with respiratory problems from those with other conditions,” says Dr Jay Banerjee, who leads the Royal College of Emergency Medicine’s work on emergency care for the elderly. “But most just do not have the capacity to also try to separate elderly patients with other conditions from younger patients.” Read full story Source: The Guardian, 27 May 2020
  10. News Article
    Weston General Hospital has stopped admitting new patients – including to the accident and emergency department – following a spike in coronavirus cases. The hospital announced yesterday it was taking this “precautionary measure” due to the “high number of coronavirus patients” on site. MP for Weston-super-Mare John Penrose tweeted that he had spoken to local health chiefs and a deep clean is being carried out at the hospital “following a spike in infections”. He added that a temporary A&E has been set up outside the hospital, while inpatients will be re-directed to hospitals in Taunton or Bristol. Out of hours GP practices, pharmacies and walk-in services at the minor treatment unit in Clevedon and Yate have also been given as alternative options for patients seeking medical treatment. Read full story Source: HSJ, 25 May 2020
  11. News Article
    A hospital A&E department has been rated "inadequate" after inspectors found patients at "high risk of avoidable harm". The Care Quality Commission (CQC) reported a "range of regulation breaches" and a shortage of nurses at Stepping Hill hospital's A&E unit. It also criticised maternity and children's services. Stockport NHS Foundation Trust's chief executive said the trust had taken "immediate steps" to improve. The CQC inspected Stepping Hill Hospital in January and February and found A&E performance "had deteriorated significantly" since its last inspection in 2018. Inspectors found shortcomings "relating to patient-centred care, dignity and respect, safe care and treatment, environment and equipment, good governance, and staffing". Their report said the service "could not assure itself that staff were competent for their roles" and patient outcomes "were not always positive or met expectations in line with national standards". Read full story Source: BBC News, 19 May 2020
  12. News Article
    A&E admissions in the UK have fallen to the lowest on record, with a 57% year-on-year drop in attendances in England, new NHS data shows. The latest figures show a dramatic fall in demand for emergency treatment, falling below one million attendances per month for the first time since records began in 2010. The coronavirus crisis has placed additional strain on NHS resources, but is thought to have had the opposite effect on A&E, with the public staying at home and avoiding hospitals where possible. Read full story (paywalled) Source: The Telegraph, 14 May 2020
  13. News Article
    "I have never seen my A&E department so still, so well-staffed and so uncannily calm," says Steven Fabes, an A&E doctor. Attendances in A&E departments across the country are down, in some cases by up to 80%. There is an obvious reason for the calm: people are not out and about. Pedestrians are not walking out in front of cyclists. Cyclists are not diving over car bonnets. Asthmatics are not wheezing through the fumes of Oxford Street. But there is something more worrying at play, too – people who need us are not coming in. "I am worried that people who need us are not coming in, scared that hospitals are vectors for infection rather than cure," says Steven. Read full story Source: The Guardian, 23 April 2020
  14. News Article
    The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned. Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them. And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden. “People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.” Read full story Source: The Guardian, 16 April 2020
  15. News Article
    Medical leaders have warned sick patients not to avoid getting help from the NHS after a huge drop in the numbers of people attending A&E departments sparked fears some could die without care. In March, the number of people going to their local emergency department fell by 600,000, or 29 per cent, compared to same month last year, the lowest number of attendances since 2010. While the NHS has battled for years to reduce the number of people going to A&E for unnecessary reasons, the sudden fall during the coronavirus epidemic has worried officials that the pandemic could be deterring people who have genuine need and who could become sicker or even die as a result of staying away. Read full story Source: HSJ, 9 April 2020
  16. News Article
    St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak. Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan. It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients. The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months. Read full story (paywalled) Source: HSJ, 18 March 2020
  17. News Article
    Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said. Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation". One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency. The Welsh NHS Confederation said staff were "committed to the highest standards of care". In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents. Read full story Source: BBC News, 10 March
  18. News Article
    A&E units are so overcrowded that growing numbers of patients have to be looked after in hospital corridors, warn nurses and doctors. There are rising concerns that the “shameful” trend means people stuck in corridors are not getting the care they need, or they may be even coming to harm. A&E health professionals say “corridor nursing” is becoming increasingly widespread as emergency departments become too full to look after the sheer number of people seeking treatment. In a survey of 1,174 A&E nurses in the Royal College of Nursing’s (RCN) Emergency Care Association, 73% of those polled said they looked after patients in a “non-designated area” such as corridors every day and another 16% said they did so at least once a week, while 90% said they feared patient safety was being put at risk by those needing care having to spend time in areas of hospitals which did not have medical equipment or call bells. Staff have had difficulty administering urgent doses of intravenous antibiotics to such patients, some of whom have been denied privacy and found it harder to use a toilet or been left in distress, nurses said. Read full story Source: The Guardian, 26 February 2020
  19. News Article
    A double amputee suffered fatal pressure sores caused by "gross and obvious failings" in her hospital treatment. Janet Prince, from Nottingham, developed the sores after being admitted to Queen's Medical Centre (QMC) in July 2017. The 80-year-old died in January 2019. Assistant Coroner Gordon Clow issued a prevention of future deaths report to Nottingham University Hospitals NHS Trust (NUH). Nottingham Coroner's Court had heard Ms Prince was taken to QMC in Nottingham with internal bleeding on 15 July 2017. The patient was left on a trolley in the emergency department for nine hours and even though she and daughter Emma Thirlwall said she needed to be given a specialist mattress, she was not given one. "No specific measures of any kind were implemented during that period of more than nine hours to reduce the risk of pressure damage, even though it should have been easily apparent to those treating her that [she] needed such measures to be in place," Mr Clow said. Ms Prince was later transferred to different wards, but a specialist mattress was only provided for her a few days before she was discharged on 9 August, by which time Mr Clow said her wounds "had progressed to the most serious form of pressure ulcer (stage four) including a wound with exposed bone". Mr Clow said there were "serious failings" over finding an appropriate mattress and other aspects of her care while at the QMC, including "a gross failure" to prevent Ms Prince's open wounds coming into contact with faeces. Mr Clow said the immediate cause of her death was "severe pressure ulcers", with bronchopneumonia a contributory factor. Recording a death by "natural causes, contributed to by neglect", he said he was "troubled by the lack of evidence" of any changes to wound management at NUH. NUH medical director Keith Girling apologised for the failings in Ms Prince's care, claiming the trust had "learnt a number of significant lessons from this very tragic case". Read full story Source: BBC News, 14 February 2020
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