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Found 26 results
  1. Content Article
    C-Diff Dentures in the healthcare setting Discharge instructions Drug allergies End of life care Falls at home Getting the right diagnosis Handwashing Hospital ratings Influenza (the flu) Latex allergies Medical records Medication safety at home Medication safety: Hospital and doctor's office Metric-based patient weights MRI safety MRSA Neonatal abstinence syndrome (NAS) Norovirus (stomach flu) Obstructive sleep apneoa Pneumonia Pressure injuries (bed sores) Sepsis What is an MRI? Wrong-site surgery
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    The session described three things. Firstly, the importance of improving flow in hours – so when a bed is available and how quickly can we fill it. Secondly, reducing length of stay in days and, thirdly, working to safely keep more patients at home. During this event, where 70 people joined the conversation, colleagues in the Netherlands described the methodology of ‘Real Time Demand Capacity’ which they have implemented. It is Improvement Cymru's aim in 2021 to help improve the understanding of the science of flow using lean and to support implement these principles into our health and social care systems, which they think will have a significant impact on this problem. Watch the webinar and read the accompanying blog from Iain Roberts, Head of Programmes.
  4. News Article
    Trusts in more than half English local authorities still do not have an agreed safe place to discharge recovering covid patients to, despite the government asking councils to identify at least one such ‘designated setting’ by the end of October. The situation is leading to an increase in delayed discharges from hospital just as the service comes under increased pressure from the second covid wave and returning elective and emergency demand. In a letter last month, the government told local authorities to identify at least one “designated setting” – typically a care home – which hospitals could discharge covid positive patients to when they no longer need secondary care. The designated setting would also take discharged patients who had not received a negative covid test. The plan is designed to protect residents in other homes, after thousands of care home residents died due to outbreaks of the virus in the spring. But a well-placed source in the care sector told HSJ less than half of the 151 upper tier councils met the 31 October deadline, due to a range of reasons including insurance costs, fear of high mortality rates and reputational damage to the designated homes. It means that in many parts of the country, there are a lack of options when it comes to discharging patients, which is causing a rise in delayed discharges. Read full story (paywalled) Source: HSJ, 5 November 2020
  5. News Article
    Delays in discharging patients from hospitals is making pressure on the NHS from the second wave of coronavirus worse, hospital chiefs have warned. Some hospitals are already reporting almost all of their beds are full with patients as the number of coronavirus cases continues to surge with more patients needing hospital care every day. Doctors have told The Independent the lack of discharges means fewer beds are free and some hospitals are seeing long waits in A&E for beds to become available. NHS Providers chief executive Chris Hopson said: “Some of our chief executives are saying they are seeing bed occupancy levels of 92, 93, 94 per cent at the end of October when they would normally expect these to be 86, 87, 88 per cent. “Given where we are in terms of the winter cycle, and the fact we are not really at the beginning of winter yet, that is a worry." “There are much higher bed occupancy levels now than you would normally expect to see at this time of the year.” Without enough spare beds, hospitals will not be able to go ahead with planned surgeries and will have to make patients wait longer for a bed in accident and emergency departments. Read full story Source: The Independent, 30 October 2020
  6. 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
  7. 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
  8. 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.
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    Key findings: Wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success. Common challenges included obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation. The authors concluded that a supportive hospital culture is essential for successful RED implementation. A flexible implementation strategy can be used to implement RED and reduce readmissions.
  11. Content Article
  12. News Article
    Serious patient safety and wellbeing concerns about the latest hospital discharge guidance have been raised to HSJ by senior clinicians and charities. Senior geriatricians warned that the guidance could prompt an increase in “urgent readmissions”, “permanent disability” and “excess mortality”, while charities said families could be left with “unsustainable caring responsibilities” because of the new rules. The government guidance, Hospital Discharge Service: policy and operating model, published in August, said clinicians should consider discharging patients when they were “medically optimised” rather than “medically fit”. It said 95% of these patients would return straight home with additional social care and rehabilitation support if needed. Many of the concerns raised surround the retention of the “criteria to reside”. This was originally agreed in March when there was a push from NHS England to free up acute beds over fears hospitals would become overwhelmed with covid admissions as the pandemic hit the UK. The criteria has, however, been maintained in the new guidance, despite a significant fall in infections and deaths from the virus. Rachel Power, chief executive of The Patients Association charity, warned: “This guidance makes it clear that the NHS is still having to take drastic emergency action in the face of covid-19, that will continue to take a heavy toll on patients. It is clear that many patients will be rushed home who would normally have had a longer period of hospital care.” Read full story (paywalled) Source: HSJ, 8 September 2020
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  16. News Article
    Problems with hospital discharges in England, highlighted in the largest annual patient survey, reinforce the need for greater integration between health and social care, the sector regulator has said. The Care Quality Commission inpatient survey found that a majority of patients were positive about their hospital care but a significant minority experienced problems on discharge. A third of respondents who were frail said the care and support they expected when they left hospital was not available when they needed it. Three in 10 frail people said they had not had discussions with staff about the need for further health and social care services they might require post-discharge. Four in 10 of all patients surveyed left hospital without printed or written information about what they should or should not do after discharge, and the same proportion said their discharge was delayed. Read full story Source: The Guardian, 2 July 2020
  17. Content Article
    Key findings Most questions on the theme of being treated in a respectful and dignified manner continued a trend of sustained improvement over the last 3-6 years. Results show communication between staff and patients before and after operations is improving. Patients continue to report positively when asked about the cleanliness of the hospital environment, the choice of food available to them and hydration. Confidence in doctors and nurses also remains high this year. However, this year’s results indicate that there are areas in need of improvement: Patients consistently reported less positive experiences for the themes of: communication at the point of discharge and consideration of the support they will need after leaving hospital. Results for information sharing in relation to medicines, including: explaining the purpose, being told about possible side effects and being given written or printed information all declined this year. The percentage of people experiencing shortages in nursing staff remains high. Certain groups of patients consistently reported poorer experiences of their time in hospital, including patients with dementia or Alzheimer’s, younger patients (aged 16 to 35) and patients who were admitted in an emergency.
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  19. News Article
    The government said it will set up ‘dedicated team’ to look for innovative ways for the NHS to continue treating people for coronavirus, while also providing care for non-covid health issues. In its pandemic recovery strategy published today, the government also said step-down and community care will be “bolstered” to support earlier discharge from acute hospitals. The 60-page document contained little new information about plans for NHS services, but said: “The government will seek innovative operating models for the UK’s health and care settings, to strengthen them for the long term and make them safer for patients and staff in a world where COVID-19 continues to be a risk. “For example, this might include using more telemedicine and remote monitoring to give patients hospital-level care from the comfort and safety of their own homes. Capacity in community care and step-down services will also be bolstered, to help ensure patients can be discharged from acute hospitals at the right time for them". To this end, the government will establish a dedicated team to see how the NHS and health infrastructure can be supported for the COVID-19 recovery process and thereafter. Read full story Source: 12 May 2020
  20. Content Article
    During the initial impact of the COVID-19 pandemic, the Government recognised that a key enabler would be to increase capacity within the NHS, ensuring that enough acute beds were available to cope with the rising tide of patients. An important policy priority has been to ensure the safe discharge of patients back into their home or, where appropriate, into a placement with a community provider. While there were already pathways in place to accelerate this process, responding to the pandemic required a significant acceleration of hospital discharges. Hospital discharges are complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to equip the home or community setting with the appropriate equipment and care plans. In this submission to the Inquiry, Patient Safety Learning and CECOPS focus on: Rapid hospital discharge - considering the challenges to this caused by the pandemic, the importance of interoperability in overcoming these, preventing care homes and nursing homes becoming vectors of transmission and harnessing digital technologies, such as an app, to assist hospital discharges. Community support - as the rate of hospital discharges significantly increases, the need to consider the availability of Personal Protective Equipment supplies, access to and guidance on supportive equipment and technologies and other pressures that will need to be met by community support services. In the concluding comments the submission sets out an eight-point action plan required to tackle this issue: A model of demand to inform hospital discharge and planning of community and care services New agile ways of working using digital technologies. An improved cross health and social care information system is imperative to ensure safe transfers of care Strengthened cross-sector leadership and communication with clinical teams and patients and families The provision of equipment services addressed urgently - to support hospital discharge and prevent admissions i.e. wheelchair, prosthetic, orthotic and equipment services Integration of planning and service delivery across sectors with the right leadership, the ability and capacity at a local level to streamline services and procurement to the needs of patients, families, and care providers Innovation in the development of safe transfers of care. We must adapt the traditional bureaucratic processes and regulatory framework to ensure that the needs of patients are met speedily Financial support to ensure that there is capacity to provide community-based care The safety of patients at the core of all plans and service delivery. All plans should include how the safety of patients is being prioritised. References [1] UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 7 May 2020. https://committees.parliament.uk/work/277/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/ [2] UK Parliament, Call for evidence: Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 29 April 2020. https://committees.parliament.uk/call-for-evidence/131/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/
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  22. News Article
    The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it. “The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine. Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices. Read full story Source: Science, 8 April 2020
  23. News Article
    A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris. A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity. While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection. One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available. Read full story Source: HSJ, 9 April 2020
  24. News Article
    A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise. The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved. In a memo sent on 8 January, three trust bosses said the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”. The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern. “It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.” Read full story Source: 14 January 2020
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