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Found 363 results
  1. Event
    Join Emergency Services Times to delve deep into fostering a culture of that encourages speaking up in emergency services, shedding light on effective strategies and leaving outdated approaches behind. Reports into culture may grab headlines but underneath, it is about behaviour and creating a working environment and channels that allow staff to have a voice, speak up and report without fear of reprisal. Through the lens of Crimestoppers and the National Guardian's Office, we look at what works and how to move on from approaches that simply don't serve the needs of those working within the emergency services sector. Register
  2. Content Article
    This report, produced in collaboration with the Association of Ambulance Chief Executives and the NHS Confederation, highlights the pivotal role ambulance trusts play in delivering urgent and emergency care and sets out a long-term vision for an enhanced role they could take in co-designing this care. It sets out the case for change and includes several case studies that demonstrate the benefits of ambulance services taking this broader approach.
  3. Content Article
    Diagnostic delays in the emergency department (ED) are a serious patient safety concern. This retrospective cohort study included children treated at 954 EDs across 8 states, and examined the association between ED volume and delayed diagnosis of first-time diagnosis of an acute, serious conditions (e.g., bacterial meningitis, compartment syndrome, stroke). The researchers found that EDs with lower pediatric volume had higher rates of delayed diagnosis across 23 serious conditions. 
  4. Content Article
    Central venous catheters (CVCs) are widely used in US critical care settings for medication administration, monitoring and reliable venous access. Despite the benefits of CVCs, complications, particularly infections, have become a major focus of US hospital quality improvement efforts due to federal and state initiatives that emphasise patient safety, transparency and accountability. In this commentary in JAMA Network, the authors look at recent research surrounding CVC complications and highlight approaches to help tackle these issues.
  5. Content Article
    Adverse safety events (ASE) are common in paediatric out-of-hospital cardiac arrests (OHCA). This retrospective chart review study sought to estimate the prevalence of adverse safety events in children under age 18 experiencing OHCA. The researchers found that 60% of those children experienced at least one severe ASE, with the highest odds of ASE occurring when the OHCA was birth-related.
  6. Content Article
    This study aimed to determine whether the use of video telemedicine for paediatric consultations to referring hospital emergency departments (EDs) results in less frequent medication errors than the current standard of care—telephone consultations. The authors found no statistically significant differences in physician-related medication errors between children assigned to receive telephone consultations vs video telemedicine consultations.
  7. News Article
    It has been well-documented that Covid-19 took a devastating toll on emergency departments nationwide, revealing and exploiting the fragility of our acute-care system. Less has been written, however, about the side effects of hospitals’ attempts to recover from that era — one of the most serious of which is the proliferation of boarding. As hospitals scramble to regain their footing (and their profit margins), the financial incentive structure that undergirds US medicine has gone into overdrive. Inpatient beds that might previously have been reserved for patients who require essential care but generate very little money for the hospital, are increasingly allocated for patients undergoing more lucrative procedures. The consequences of this systemic failure cannot be overstated. Four hours is supposed to be the maximum time spent boarding in an emergency department, but recent data shows that hospitals in the US are failing to meet that goal when occupancy is high (which it routinely is). "On any given shift, hallways in the emergency department are lined with patients on stretchers. Boarding leads to a cascade of harms — including ambulances diverted to hospitals far from patients’ homes, patients charged for beds they haven’t yet occupied and overwhelmed emergency medicine personnel leaving the field because of burnout," says Hashem Zikry, an emergency medicine physician and a scholar in the National Clinician Scholars Program at UCLA. Many narratives around boarding focus on the patients themselves, shaming some for inappropriately using the emergency department. Proposed solutions include pushing patients to urgent-care centers or modifying “patient flow.” But the issues with boarding cannot be addressed with such minor tweaks. Read full story (paywalled) Source: The Washington Post, 28 February 2024
  8. Content Article
    This is my story, as a bereaved mother, about lessons I have learnt following the unexpected death of my previously well 25-year-old daughter Gaia in University College Hospital London (UCLH) in July 2021. I have written 11 patient safety lessons in the hope this helps other families be more assertive if they have a critically sick relative in hospital. Believe me, you must be pushy to be allowed into a hospital ward, even more so ITU. I went to visit my critically sick daughter at around 10am on a Sunday morning, but was not allowed on to the ward. A senior nurse told me to GO HOME using the 'Covid' excuse. I was shut out from the bedside of my critically ill only child. I have set up TruthForGaia.com to share learnings more widely. Please take a look. I hope sharing this may contribute to reducing avoidable deaths from brain conditions which can be only too easily assumed to be intoxication, especially on weekends. I believe raised intracranial pressure (high pressure in the skull) needs more awareness and training. When will UCLH hold a medical grand round on my daughter's case?
  9. Content Article
    Strategies to reduce medication dosing errors are crucial for improving outcomes. The Medication Education for Dosing Safety (MEDS) intervention, consisting of a simplified handout, dosing syringe, dose demonstration and teach-back, was shown to be effective in the emergency department (ED), but optimal intervention strategies to move it into clinical practice remain to be described. This study aimed tov describe implementation of MEDS in routine clinical practice and associated outcomes. The study was conducted in five stages (baseline, intervention 1, washout, intervention 2, and sustainability phases). The 2 intervention phases taught clinical staff the MEDS intervention using different implementation strategies. The study found that both MEDS intervention phases were associated with decreased risk of error and that some improvement was sustained without active intervention. These findings suggest that attempts to develop simplified, brief interventions may be associated with improved medication safety for children after discharge from the ED
  10. Content Article
    When Emma Powell experienced psychosis this year, she was told to go to A&E by the mental health crisis team. But she was left waiting for a bed for three and a half days, in conditions that only made her distress worse. In this article, Emma describes several experiences of trying to access crisis care for her schizoaffective disorder. She explains the impact of long waits at A&E and how they make her condition worse, with the overcrowded and busy environment causing overstimulation, and changing staff carrying out repetitive consultations causing confusion and exhaustion.
  11. Content Article
    To tackle the serious harms, up to and including death, associated with eating disorders it is crucial that more is done to identify them at the earliest stage possible so that the appropriate care and treatment can be provided. This new guidance by the Royal College of Psychiatrists is based on the advice and recommendations of an Expert Working Group. It provides a comprehensive overview of the latest evidence associated with eating disorders, including highlighting the importance and role of healthcare professionals from right across the spectrum recognising their responsibilities in this area.
  12. Content Article
    When public areas such as train stations breach their capacity, emergency protocols are rolled out and stations are closed. Yet when hospitals become overcrowded, there isn’t the option to stop urgent and emergency care. Instead, staff have to develop workarounds, delivering care in areas not designed – nor safe or effective – for clinical use, a phenomenon commonly known as ‘corridor care’. The increasing frequency of corridor care is alarming – both for patient safety and staff morale, and because it risks normalising substandard care delivery.  Corridor care largely occurs when emergency departments are inundated with patients. 45,000 people visit major hospital A&E departments in England each day, 16% more than 10 years ago. Many of these patients require hospital admission or further care. Limited beds within hospitals, stretched community services and chronically low social care capacity mean that A&E often becomes a bottleneck, with patients unable to ‘flow’ out of the department because there are no free beds elsewhere in the hospital. In this blog, Heather Wilson a Programme and Policy Officer in the Healthy Lives team at the Health Foundation, as well as a registered nurse who continues to work in a central London emergency department discusses the impact of corridor care on staff, patients and families. Further reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift
  13. 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.
  14. News Article
    Ambulance chiefs have warned that patients are coming to harm, paramedics are being assaulted and control room staff reporting a “high stakes game of chicken” with police during the implementation of a controversial new national care model. The Association of Ambulance Chief Executives say in a newly published letter they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”. The membership body set out multiple concerns about the rollout of the model, under which the police refuse to attend mental health calls unless there is a risk to life or of serious harm. In the letter to Commons health and social care committee chair Steve Brine, AACE chair Daren Mochrie says timescales for introducing it were often “set by the police rather than “agreed” following meaningful engagement with partners”, meaning demand was shifting before health systems had built capacity. They also flag a lack of NHS funding to meet the new asks. Mr Mochrie, also CEO of North West Ambulance Service Trust, described a “grey area” relating to what he called “concern for welfare” calls, which meet neither the police nor attendance services’ threshold for attendance. “To date this is the single biggest feedback theme we have heard from ambulance services, with some control room staff describing feeling like they’re in a ‘high-stakes game of chicken’ where the police have refused to attend and told the caller to hang up, redial 999 and ask for an ambulance,” he wrote. Read full story (paywalled) Source: HSJ, 20 February 2024
  15. Content Article
    In this open letter to Steve Brine, Chair of the Health and Social Committee, The Association of Ambulance Chief Executives say they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”. It outlines key concerns, including the timescales for implementation, the consistency of application and failure by the police to attend when required.
  16. Content Article
    Studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. This study in the American Journal of Surgery aimed to identify determinants of post-intensive care physical and mental health outcomes 6–12 months after injury. The authors found that: Delirium during an intensive care unit (ICU) stay is linked with long-term physical impairment in injury survivors who spent three or more days in the ICU. The use of ventilators in the ICU is another factor associated with long-term physical impairment and mental health symptoms in these patients. Delirium and ventilator use are potentially modifiable, suggesting opportunities for improving patient outcomes. They suggest that that this knowledge can inform the development of interventions that specifically target delirium and ventilator use to mitigate long-term impairments.
  17. Content Article
    Emergency general surgery (EGS) involves care and treatment of a patient's often previously unknown disease in an unplanned interaction with the healthcare system. This leads to challenges in collecting and interpreting patient reported outcome measures (PROMs). This study in the American Journal of Surgery aimed to capture the peri-operative experiences of 30 patients at 6 to 12 months after their treatment. The authors found that: two-thirds reported feeling no choice but to pursue emergency surgery with many reporting exclusion from decision-making. Females reported these themes more commonly. patients with minor complications less frequently reported trust in their team and discussed communication issues and delays in care. patients with major complications more frequently reported confidence in their team and gratefulness, but also communication limitations. patients not admitted to the ICU more frequently discussed good communication and expeditious treatment.
  18. Content Article
    Prolonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours. 
  19. Content Article
    This infographic is a visual representation of the WHO Emergency Care System Framework, designed to support policy-makers wishing to assess or strengthen national emergency care systems. It is the result of global consultations with policy-makers and emergency care providers and provides a reference framework to: characterise system capacity. set planning and funding priorities. establish monitoring and evaluation strategies.
  20. News Article
    Hospitals are being pressured to shift their resources to treating patients with less serious conditions to meet a “politically motivated” target, according to multiple senior sources. The pressure appears to be coming through NHS England’s regional teams, with local sources saying they are being told to focus energies on patients in their emergency departments who do not need to be admitted to a ward. These cases are typically faster to deal with, and therefore shifting resources to this cohort could significantly improve performance against the four-hour target. However, experts in emergency care repeatedly warn that admitted patients are the most likely to suffer long waits and harm. The NHS has been tasked with lifting performance against the four-hour target to 76% in 2023-24, but has failed to meet that in any month this year. Performance in December was 69%. Some trust leaders told HSJ they would ignore the instructions, saying they would continue to focus resources on reducing the longest waits. One chief executive in the north of England said: “It’s a complete nonsense and just politically motivated. We’re getting a very clear message to hit 76 per cent which is hugely problematic because it will drive non patient focussed behaviour. We have said ‘no, we are focussing on long waiters and ambulance delays’… in other words doing the right thing for patients.” Read full story (paywalled) Source: HSJ, 5 February 2024
  21. Content Article
    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. This study found that lean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.
  22. News Article
    Reductions in the number of long ambulance delays have come at a “huge cost” as hospitals are having to take in more emergency patients than they have space for, NHS England’s urgent care director has said. Sarah-Jane Marsh told NHS England’s board meeting on Thursday that emergency departments and hospital wards are now taking more “risk” by taking extra patients in a bid to get ambulances back on the road quicker. This year, many fewer hours have been lost to ambulance delays, although the total number of delays of more than 60 minutes is approaching the same as last winter. Emergency department waits in November and December were better than last year, although still much worse than pre-covid and a long way below targets. But Ms Marsh said the improvement was a result of hospitals agreeing to take more patients into EDs and acute wards, even when they did not have space or staff to properly care for them. She said: “It’s come at a huge cost. Some of the things we have achieved are because we have moved pressures around in the system. “We have moved risk out of people’s houses and from the back of ambulances, and in some cases we’ve moved that into emergency departments [and] wards, that have had to take the pressure of taking additional patients. “Next year one of our learnings is that we need to have a really big focus on what is happening inside our hospitals [so] we decongest some very crowded areas.” Read full story (paywalled) Source: HSJ, 1 February 2024
  23. 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.
  24. News Article
    Boston-based Massachusetts General Hospital is requesting permission from the state to add more than 90 inpatient beds amid what it says is an "unprecedented capacity crisis." The hospital's emergency department has experienced critical levels of overcrowding nearly every day for the past six months, Massachusetts General said in a news release. The hospital boards between 50 to 80 ED patients every night who are waiting for a hospital bed to open. On 11 January, Massachusetts General had 103 patients boarding in the ED, representing one of the most crowded days in the hospital's more than 200-year history. "While hospital overcrowding has significantly affected patient care for many years, COVID-19 and the post-pandemic demand for care has escalated this challenge into a full-blown crisis – for patients seeking necessary emergency care, as well as for staff who are required to work under these increasingly stressful conditions," David F.M. Brown, president of Massachusetts General, said in a news release. Massachusetts General's request comes as hospitals across the state grapple with capacity issues, workforce shortages and a jump in respiratory illnesses this winter. On 9 January. the Massachusetts Department of Public Health issued a memo urging hospitals to expedite discharge planning amid the capacity crunch. Some health plans have also waived the need to obtain prior authorisation for short stays in post-acute care facilities. Read full story Source: Becker Hospital Review, 19 January 2024
  25. Event
    until
    Fundamentals of Emergency Medicine Education is a 2-day, 17-hour course that provides participants with the knowledge and skills to become effective educators in emergency medicine. Through a dynamic and interactive format, the course focuses on best practice, strategies, updates, and educational innovations to optimize the educational environment in your Emergency Department. This course is designed for faculty at any career stage who work with trainees and are seeking a comprehensive foundation in medical education. The goal of this course is to teach fundamentals of medical education to improve the teaching and learning in your department. Register
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