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Found 49 results
  1. Content Article
    This blog calls for action on the careful review of established pain medication when a patient is admitted to hospital. Richard describes the experience of two elderly patients who suffered pain due to their long term medication being stopped when they were admitted to hospital. Pain control needs must not be ignored or undermined, there needs to be carer and patient involvement and their consent, and alternative pain control must be considered.
  2. News Article
    A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ. Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023. The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system. She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.” Read full story (paywalled) Source: HSJ, 8 November 2023
  3. Content Article
    Urgent funding is required to clear waiting list backlogs and drive Northern Ireland's long-term healthcare transformation, the Northern Ireland Audit Office has said in a new report which outlines the health service's "critical situation" after almost a decade of worsening waiting lists for elective care. The NI Audit Office looked at waiting list data from 2014 to 2023. It found the number of patients waiting for elective care has risen by 452,000 during that nine-year period. The Audit Office also said: "Available information suggests waiting list performance levels are significantly worse in Northern Ireland compared with the other UK regions."
  4. Content Article
    All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were (1) to analyse the association between IHA and the development of subsequent AEs; and (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. It found that patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.
  5. News Article
    A ‘disappointingly slow’ transformation of community services means thousands of mental health patients are still presenting at emergency departments within weeks of being discharged from an inpatient facility. Experts said an NHS England-led community transformation programme, launched in 2019 as part of a £2.3bn investment in mental health services, should have helped reduce readmission rates, but internal data seen by HSJ suggests the rates have actually increased since then. The data reveals for the first time the proportion of patients discharged from inpatient care who then present to accident and emergency within two months. The proportion of adult patients was 11 per cent in 2018-19, when the investment programme was launched, and had increased to 12 per cent by 2022-23, representing around 6,000 adult cases. The situation appears worse for children, with an 18 per cent readmission rate within two months, up from 17 per cent in 2018-19. Read full story Source: HSJ, 8 August 2023
  6. Content Article
    Successful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
  7. News Article
    Almost 900,000 older people are admitted to hospital every year as an emergency because the NHS is failing to keep them healthy at home, Age UK has warned. A major lack of services outside hospitals means elderly people are also suffering avoidable harm, such as falls and urinary tract infections, the charity said. In a new report it urges NHS bosses to push through huge changes to how the “hospital-oriented” service operates and establish “home first” as the principle of where care is provided. Doing so would reduce the strain on overcrowded hospitals and leave the NHS better set up to respond to the increase in the number of over-65s and especially over-85s, Age UK said. Its report, on the state of health and care of older people in England, concluded that “our health and care system is struggling, and too often failing, to meet the needs of our growing older population.” Read full story Source: The Guardian, 11 July 2023
  8. Content Article
    Over the two decades before the pandemic, the number of NHS patients admitted to hospital increased year-on-year, despite a reduction in the number of hospital beds. Since the Covid-19 pandemic, fewer patients have been admitted to NHS hospitals and length of stay has risen, raising questions about NHS productivity, quality of care and the prospects of meeting ambitions to recover services. This report by the Health Foundation analyses data around hospital admissions and suggests reasons for these trends.
  9. News Article
    A reduction in the number of GP referrals to hospitals could be creating a "hidden backlog" of patients needing help, according to a new report. The study by the Institute for Government (IFG) and Public First says that not enough data is published about the "advice and guidance" referral system. Family doctors have been told to reduce the number of people they refer for hospital care by using the 'advice and guidance' route – whereby a GP will call or email a hospital doctor to ask for advice on whether or not a referral is required. The method has been used since 2015 but NHS England introduced a target for GPs to have 12 "advice and guidance" patients for every 100 outpatient appointments in October 2021 in an attempt to reduce the backlog of hospital care. This has now increased to 16 but it has been reported that as many as 22 out of 100 potential hospital appointments are being handled this way. The IFG and Public First report states: "There is a risk that GPs making fewer referrals – in part to address hospital capacity concerns – is creating a 'hidden backlog' by allowing treatable conditions to deteriorate and possibly leading to more unplanned admissions." Read full story Source: Medscape, 14 June 2023
  10. Content Article
    Hospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.
  11. Content Article
    Physicians raised a concern to the Quality Department about patients who were diagnosed in the emergency department (ED) with a urinary tract infection (UTI) but who later were clinically reviewed and found to be without disease. These patients were often admitted and treated with potentially unnecessary antibiotics.
  12. News Article
    Hospitals are not able to cope with current pressures, senior doctors have warned, as a new study links long A&E waits to an increased risk of death. Patients waiting more than five hours within an emergency department are at an increased risk of dying, according to a study published in the Emergency Medicine Journal (EMJ). The study’s findings come as emergency care performance across England continues to deteriorate, and as pressures across hospitals mean that more patients are waiting for more than four hours in A&E departments than ever before. According to the research, death rates for patients waiting between six and eight hours before admission to hospital were 8% higher, and they were 10% higher for those waiting eight to 12 hours. The study was based on data collected prior to the pandemic, and national A&E waiting times have since deteriorated further. In November last year, the Royal College of Emergency Medicine (RCEM) warned that long delays and overcrowding in A&Es may have caused thousands of deaths during the pandemic. Researchers said that although cause and effect could not be established between longer waits and deaths after 30 days of hospital admission, they recognised a statistically significant trend. The paper said: “Long stays in the emergency department are associated with exit block and crowding, which can delay access to vital treatments. And they are associated with an increase in subsequent hospital length of stay, especially for older patients. Read full story Source: The Independent, 19 January 2022
  13. News Article
    Failings by NHS 111 contributed to the death of an autistic teenager, a coroner has ruled. Hannah Royle, 16, suffered a cardiac arrest as she was driven to hospital by her parents after a 111 algorithm failed to notice she was seriously ill. A coroner said her death had exposed a risk people were being misled about the capability of the system and its staff. An NHS spokesperson said it would act on the findings and learnings "where necessary". Hannah's father Jeff Royle said he regretted dialling 111 and wished he had taken his daughter straight to hospital. "I feel so dreadful, that I have let her down and she has been let down by the NHS," he said. Read full story Source: BBC News, 20 October 2021
  14. News Article
    Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections. Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus. "Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme. "The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days." Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive." He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid." Read full story Source: The Independent, 14 October 2020
  15. News Article
    The number of people being admitted to hospital with COVID-19 is rising in some regions but "few, if any" are from care homes, according to an NHS leader. Younger people are making up most of coronavirus hospital admissions, with 70% of admissions in one hospital consisting of under-45s, NHS Providers chief executive Chris Hopson said. Although the number of hospital admissions is "ticking up" in areas most affected by the Indian Covid variant, the rise is small compared with the levels seen earlier in the year. Speaking to Times Radio, Mr Hopson said most hospitalisations were among younger people and those who have been offered the vaccine but have yet to take up the offer. A number are among those who have only had their first dose of a COVID-19 vaccine, while “a very small number” are fully vaccinated with both doses. Read full story Source: The Independent, 26 May 2021
  16. Event
    Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. WHO Patient Safety Flagship has initiated a series of monthly webinars on the topic of “WHO Global Patient Safety Challenge: Medication Without Harm”,. The main objective of the webinar series is support implementation of this WHO Global Patient Safety Challenge: Medication Without Harm at the country level. Considering the huge burden of medication-related harm, Medication Safety has also been selected as the theme for World Patient Safety Day 2022. With each transition of care (as patients move between health providers and settings), patients are vulnerable to changes, including changes in their healthcare team, health status, and medications. Discrepancies and miscommunication are common and lead to serious medication errors, especially during hospital admission and discharge. Countries and organizations need to optimise patient safety as patients navigate the healthcare system by setting long-term leadership commitment, defining goals to improve medication safety at transition points of care, developing a strategic plan with short- and long-term objectives, and establishing structures to ensure goals are achieved. At this webinar, you will be introduced to the WHO technical report on “Medication Safety in Transitions of Care,” including the key strategies for improving medication safety during transitions of care. Register
  17. Content Article
    The Quality Network for Inpatient Working Age Mental Health Services (QNWA) based within the Royal College of Psychiatrists' Centre for Quality Improvement are pleased to announce the publication of their 8th edition standards. Since the publication of the first edition standards in 2006, the Network has grown to include over 140 members from the NHS and private sector. This new edition of standards aims to reflect the changes in working practices and legislation over the last two years in addition to placing greater emphasis on equality, diversity and inclusion as well as sustainability in inpatient mental health services. The eighth edition standards have been drawn from key documents and expert consensus and have been subject to extensive consultation with professional groups involved in the provision of inpatient mental health services, and with people and carers who have used services in the past.
  18. Content Article
    This report published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looked to identify and explore remediable factors in the clinical and organisation of the physical healthcare provided to adult patients admitted to a mental health inpatient setting.  The report suggests that a physical healthcare plan should be developed when patients are admitted to a mental health inpatient setting. Other key messages aimed at improving care include calls to: formalise clinical networks/pathways between mental health and physical health care; involve patients and their carers in their physical health care, and use admission as an opportunity to assess and involve patients in their general health, and include mental health and physical health conditions on electronic patient records.
  19. Content Article
    It is 20 years since researchers discovered that patients admitted to hospitals on Saturdays or Sundays are more likely to die than those admitted Monday to Friday. The ‘weekend effect’ was assumed to be because fewer hospital specialists work at weekends, meaning care was less good. However, there was no evidence to support this assumption. This NIHR Alert is based on: This NIHR Alert is based on: Bion J, and others. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. Health Services and Delivery Research 2021;9:13.
  20. Content Article
    Reducing hospital bed days is currently the ultimate currency in healthcare. Large amounts of money seem to increasingly be diverted from tried and tested workforces into new services, new jobs, and new technology in order to prevent patients being admitted to hospital. Some of these new ideas could work well, while others have the potential to be a catastrophe, but what unites them all is a focus on a single outcome: saving bed days in the acute hospital. But The NHS's single minded pursuit of admission avoidance risks ignoring other important outcomes, writes Alison Leary in this BMJ opinion piece.
  21. News Article
    New artificial intelligence software being rolled-out in NHS hospitals will be able to predict daily A&E admissions weeks in advance. The software, which launched in 100 hospitals across England on Monday, analyses data, including Covid infections rates, 111 calls and traffic to predict the number of patients that will seek emergency care. It also takes into consideration public holidays, such as New Year’s Eve, when A&E is more likely to be busy. The AI software is being rolled after trials showed an “impressive” ability to forecast admissions up to three weeks in advance. The NHS believes it will help tackle the record waiting list and allow hospitals to more easily manage their patient and bed capacity, prepare for busier days and staff up when needed. Nine trusts were given the software to use during the pandemic which notified them of expected spikes in cases, staff levels and numbers of beds and equipment necessary. However, hospitals receiving the new equipment have also been warned uncertainties within the data mean the system should be used as a “starting point to consider an operational response, not as a definite signal for action.” Read full story Source: The Independent, 28 March 2022
  22. News Article
    The use of temporary treatment areas for patients arriving via ambulance at over-crowded A&Es is ‘borderline immoral’ and ‘a danger to patient safety and dignity’, the Royal College of Emergency Medicine has warned. The college said NHS England had told regional bosses to prepare to errect more of the so-called “tents” outside their major emergency departments as part of plans to get a grip on ambulance handover delays, which have reached record highs in the last two weeks. Senior figures also told HSJ that trusts have been instructed by NHS England to call the overflow facilities “temporary external structures” and not tents – a move also criticised by RCEM president Katherine Henderson. Dr Henderson told HSJ: “Using tents is just wrong on every level… We’ve been down this route before. It doesn’t work. It’s a huge distraction, and I think what upsets me the most about it is it creates the appearance that people are taking action when it’s not the action that will deal with the problem.” In an opinion piece for HSJ, Dr Henderson says: “We find ourselves in the completely unacceptable situation where the ‘solution’ to ambulance handover problems is to put up tents or sheds in front of emergency departments – euphemistically being called ‘temporary external structures’. “Trust leaders and NHS England must not be afraid to stand up and make this case – putting patients in tents is a bad, borderline immoral bodge job to treat the symptom rather than cause, and our patients need to see some real leadership to protect them." Read full story (paywalled) Source: HSJ, 25 March 2022
  23. News Article
    Several trusts have now started reporting thousands of 12-hour waits in their emergency departments, representing a huge difference to the numbers published nationally under a slightly different measure. This year, trusts have started submitting data to NHS England on the number of patients waiting over 12 hours from time of arrival in ED, until discharge, admission or transfer. Many trusts are now reporting these statistics in their public board reports. This is a slightly different measure to the publicly reported “trolley wait” figures, which count waits of over 12 hours from decision to admit until admission. Experts have long argued the trolley wait measure does not capture the true problem of ED overcrowding and delayed care. The new data captures a far higher number of patients and has not been published nationally by NHSE. Read full story (paywalled) Source: HSJ, 2 August 2022
  24. News Article
    Admissions of people to hospital with Covid in England have begun to grow again, new data from the NHS shows, as fears were raised over a new wave. Analysis by John Roberts of the Covid Actuaries group, set up in response to the pandemic, showed hospital admissions had stopped falling after a period of decline. Figures on Tuesday showed weekly admissions increased by 4% across England as of 5 June and were up by 33% in the North East and Yorkshire. When asked if the UK was heading into another wave, Mr Roberts told The Independent: “Yes we could be but...how big that wave and how serious it will be in terms of admissions and deaths is very, very difficult to judge at this stage.” His comments come after experts in Europe warned there will be a new wave driven by the growth of the BA.5 and BA.4 Covid variants. The figures, which cover hospitals in England only, show the weekly average of admissions for patients in hospital with Covid stood at 531 as of 5 June. Read full story Source: The Independent, 9 June 2022
  25. News Article
    NHS 111 sends too many people to accident and emergency departments because its computer algorithm is “too risk averse”, the country’s top emergency doctor has warned. Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), said that December was the “worst ever” in A&E with 9 in 10 emergency care leaders reporting to the RCEM that patients were waiting more than 24 hours in their departments. Asked what measures could help improve pressures in emergency care, Dr Boyle said more clinical input was needed in NHS 111 calls. “In terms of how we manage people who could be looked after elsewhere, the key thing to do is to improve NHS 111,” Dr Boyle told MPs. “There is a lack of clinical validation and a lack of clinical access within NHS 111 - 50 per cent of calls have some form of clinical input, there’s an awful lot which are just people following an algorithm.” Dr Boyle added where clinical input is lacking “it necessarily becomes risk averse and sends too many people to their GP, ambulance or emergency department”. Read full story (paywalled) Source: The Telegraph, 24 January 2023
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