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Showing results for tags 'ED admission'.
Found 18 results
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Content ArticleThe aims of this study were to assess whether delayed admission from the emergency department (ED) influenced mortality risk, length of acute hospital stay, risk of developing delirium and return to domicile for patients presenting with a hip fracture. It found that delayed disposition from the ED was associated with an increased mortality risk and longer length of hospital stay in patients presenting with a hip fracture.
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News Article
'I'm traumatised now': Covid bereaved call for inquiry into NHS 111
Patient Safety Learning posted a news article in News
Hundreds of people believe the helpline failed their relatives. Now they are demanding their voices be heard. Families whose relatives died from COVID-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home. The COVID-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care. “We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72. Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have COVID-19. The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care. “Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said. Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue. Read full story Source: The Guardian, 21 September 2020 -
News Article
Coronavirus: People told to phone ahead before going to A&E in Wales
Patient Safety Learning posted a news article in News
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 -
Content ArticleOn 23 September, Improvement Cymru, the all-Wales Improvement service for NHS Wales, hosted an online session with colleagues from Holland to talk about patient flow in hospital. 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.
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Content Article
How NHS staff handle acute pressure in A&Es (June 2018)
Claire Cox posted an article in Stories from the front line
In Wales, like in England, the government has come under pressure over the poor performance of parts of the service. The Betsi Cadwaladr Health Board is the largest in Wales. It also has the worst A&E waiting times and has been in special measures for three years. Its hospital in Bangor, Ysbyty Gwynedd, serves 193,000 people, from tourists visting Snowdonia to the many retirees who live in North Wales. In this film, Saleyha Ahsan, looks at how the department tries to cope with unrelenting demand for patient space. -
Content ArticleWinter 2017/18 saw an unprecedented demand for health and care support services. Emergency departments bore the brunt of this demand. This report from the Care Quality Commission (CQC) calls for wider action for health and social care services to work together. A joint approach will help the whole health and care system to manage capacity as demand grows. The same approach can encourage early and effective planning - for all periods of peak demand. This report features practical solutions from staff. Frontline clinicians attended workshops to help highlight the issues and identify what needs to change to keep services safe when facing surges in demand.
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Content ArticleReducing emergency admissions from care homes has the potential to reduce pressure on hospitals. This is a significant national policy focus, as demonstrated by a strong commitment to improve support in care homes in the NHS Long Term Plan. Key points: Analysis of a national linked dataset identifying permanent care home residents aged 65 and older and their hospital found that on average during 2016/17 care home residents went to A&E 0.98 times and were admitted as an emergency 0.70 times. Emergency admissions were found to be particularly high in residential care homes compared with nursing care homes. A large number of these emergency admissions may be avoidable: 41% were for conditions that are potentially manageable, treatable or preventable outside of a hospital setting, or that could have been caused by poor care or neglect. Four evaluations of initiatives to improve health and care in care homes carried out by the Improvement Analytics Unit (IAU) in Rushcliffe, Sutton, Wakefield and Nottingham City show reductions in some measures of emergency hospital use for residents who received enhanced support. There are key learnings from these IAU evaluations, including a greater potential to reduce the need for emergency admissions and A&E attendance in residential care homes and the benefit of coproduction between health care professionals and care homes.
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Content ArticlePete Smith is nothing without the energy and commitment of the amazing people who surround him. Increasing the technical skill of a healthcare clinician makes for incremental change. Improve the culture within which they work, think and communicate and suddenly quantum change is possible. Two perioperative nurses from a regional hospital in Victoria, Australia, innovated a simple, elegant solution to the problem of noise and distraction in the operating room. Pete Smith was one of them.
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Content ArticleThe Care Quality Commission (CGC) is the independent regulator of health and adult social care in England. They make sure that health and social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve. Independent acute hospitals play an important role in delivering healthcare services in England, providing a range of services, including surgery, diagnostics and medical care. As the independent regulator, the CQC, hold all providers of healthcare to the same standards, regardless of how they are funded. In this report the CQC have seen much good and outstanding care, in particular around: responsiveness staff interactions with patients effective treatment leadership and engagement with staff and patients. However, there were a number of areas where services needed to make substantial improvements: governance clinical audit safety culture.
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Content ArticleThis pneumonic is for quick diagnosis / risk assess for coronavirus developed by doctors in Italy.
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Content Article
Integrity in health care: a nurse's story
Claire Cox posted an article in Stories from the front line
Karen Sanders, Senior Staff Nurse at North Bristol NHS Trust, describes the moral challenges of working in a busy Emergency Department. -
Content Article
HSJ Patient Safety Congress 2018 - Alison Phillips' Story
Claire Cox posted an article in Patient stories
Alison Phillips tells HSJ her story and why she's campaigning for the deteriorating patient and safety. -
Content Article
Capnography: No Trace = Wrong Place
Patient Safety Learning posted an article in High risk areas
The Royal College of Anaesthetists (RCoA) and the Difficult Airway Society (DAS) have collaborated to create the video resource Capnography: No Trace = Wrong Place. Presented by Professor Tim Cook, the video shares the important message that during cardiac arrest, if a capnography trace is completely flat, oesophogeal intubation should be assumed until proven otherwise. -
News Article
Long A&E waits for hip breaks can increase odds of death
Patient Safety Learning posted a news article in News
People who face long waits in A&E after fracturing a hip are at higher risk of death, a study suggests. Patients who wait more than four hours are also more likely to have a longer stint in hospital, experts found. Researchers examined data on hip fracture patients aged 50 and over at a trauma centre in Lothian, Scotland, between January 2019 to the end of June 2022. Delayed disposition from our emergency department was associated with an increased mortality risk and longer length of hospital stay in patients presenting with a hip fracture Academics found that the odds of still being alive three months after hospital admission were “significantly lower” for patients who were in A&E for more than four hours compared to those who spent less time in the emergency room. Those who waited more than four hours had a 36% increased odds of dying within 90 days after their hip break compared to those who spent a shorter period in A&E. The researchers said that the increased risk is the equivalent of “one additional death at 90 days for every 36 patients who waited longer than 4 hours in the emergency department”. In light of the findings, the Royal Infirmary of Edinburgh has introduced a new “fast track” service so the majority of patients with hip fracture wait for no more than two hours in the emergency room. Lead author Dr Nicholas Clement, from the Royal Infirmary of Edinburgh and the University of Edinburgh, said: “We’ve developed a fast track care pathway, just in the knowledge of what this study is found and as part of a quality improvement project. “Our patients – those that don’t have to like another problem like a heart attack or a chest infection and can go straight at the ward – they go to the ward within two hours now. “The best thing is that they spend as little time in the emergency department as possible and go to the ward, because they need to come in the hospital anyway – they’ve got a hip fracture, it’s not like any decision needs to be made, they need to come straight in the hospital to get the hip fracture fixed.” Read full story Source: The Independent, 8 October 2024 -
Content Article
Prevention of Future Deaths report – Hannah Royle (4 October 2021)
Mark Hughes posted an article in Coroner reports
Hannah Royle was a sixteen-year-old girl on the autism spectrum. Her parents had contacted the NHS 111 service on 20 June 2020 after she became unwell with vomiting and diarrhoea, but they were not advised to go to hospital. Three hours later as her conditioned worsened they phoned again, and the call handler, who took advice from a clinical adviser, opted not to call an ambulance and instead told her parents to make their own way to hospital. She died following a cardiac arrest as she was driven to hospital by her parents. In her findings the Coroner states that the NHS 111 service failed to provide the appropriate triage for Hannah on the information provided to them by her parents. This resulted in a cardio-respiratory arrest arising from an avoidable delay in being adequately resuscitated either by prompt attendance of the emergency services or through earlier admission into hospital. In her report the Coroner notes the following matters of concern: Both calls to the 111 service were significantly non-compliant; the call handlers did not correctly complete the algorithm, they did not take into consideration Hannah’s disabilities and inability to verbalise, they failed to recognise Hannah as a complex case requiring transfer to a more senior member of the 111 service despite Hannah’s parents providing sufficient information for that to be the case. The 111 service does not have a sufficiently robust system to manage members of the public with underlying disabilities in that no accommodation is given for it in the completion of the algorithm. The skill and expertise of the ‘clinical advisor’ was wholly inadequate for her position as she had no contemporaneous or relevant experience in working in an emergency department as a nurse. She was also insufficiently robust in her assessment and understanding of Hannah’s condition when the call handler contacted her for advice. Members of the public who contact the 111 are ill-informed with a real risk they are being misled over the role and capability of the 111 service. There is little clarity or understanding by the public that it is based on following and completing an algorithm by individuals who have no need for any qualification in health care and who will only receive a short training programme after they are employed. Hannah’s parents indicated that if they knew this, they would have opted to ring 999 and the outcome would have been different. The 111 service is not a ‘diagnostic’ service yet the ‘call handlers’ have been renamed ‘health advisors’. This is misleading to the public as it implies professionalism which is untrue given their underlying skills and unsubstantiated given it is their role to complete an algorithm. The NHS pathway for ‘Abdominal Pain’ is insufficiently robust or sufficiently discriminatory to effectively deal with the myriad of potential symptoms associated with this complaint. This report was sent to NHS England and NHS Improvement, Health Education England, NHS Digital and South East Coast Ambulance Service. -
News ArticleFailings 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
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News Article
Ambulance handover delays at A&E are putting patients at risk
Patient Safety Learning posted a news article in News
Between April 2020 and March 2021 there were approximately 185,000 ambulance handovers to emergency departments throughout Wales. However, less than half of them (79,500) occurred within the target time of 15 minutes. During that period there were also 32,699 incidents recorded where handover delays were in excess of 60 minutes, with almost half (16,405) involving patients over the age of 65 who are more likely to be vulnerable and at risk of unnecessary harm. Data published by the Welsh Government highlighted that in December 2020 alone, a total of 11,542 hours were lost by the ambulance service due to handover delays. This figure has been rising sharply and has now reached pre-pandemic levels once again. Inspectors said these delays have consistently led to multiple ambulances waiting outside A&E departments for excessive amounts of time, unable to respond to emergencies within their communities. "These delays have serious implications on the ability of the service to provide timely responses to patients requiring urgent and life-threatening care," the report stated. Read full story Source: Wales Online, 7 October 2021 -
Content ArticleChildren presenting to district general hospitals with critical illness may need transfer to a Paediatric Intensive Care Unit (PICU) by a specialist retrieval team. Learning from these PICU transfers would help local hospitals identify areas for improvement to enhance patient safety and clinical care. Local hospital paediatricians often rely on updates from their retrieval service for information about their patients transferred to PICU. The project aim was to establish a monthly multi-disciplinary analysis of all the Paediatric cases transferred from the Paediatric Emergency Department and the Paediatric ward at the Royal Free, to identify areas of clinical learning and patient safety improvement.
