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Found 108 results
  1. Content Article
    The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published Recovery Beyond Survival, a review of the quality of rehabilitation care provided to patients following an admission to an intensive care unit. Based on 1,018 patients aged 18 and over who were admitted as an emergency to an ICU for four or more days between 1st October and 31st December 2022 (and who survived to hospital discharge), this report covers a range of specialities and ward areas, and identifies areas for improvement. Themes that emerge include the need for co-ordinated multidisciplinary care and good communication between professional groups, patients and their families. It also contains examples of excellent practice, such as early assessment for rehabilitation, the setting of short-term rehabilitation goals, the use of patient diaries, providing a leaflet on discharge with information about the availability of ongoing support, and the provision of follow-up appointments with the critical care team. This report goes on to make recommendations to support national and local quality improvement initiatives: Improve the co-ordination and delivery of rehabilitation following critical illness at both an organisational level and at a patient level. Develop and validate a national standardised rehabilitation screening tool to be used on admission to an intensive care unit. Undertake and document a comprehensive, holistic assessment of the rehabilitation needs of patients at risk of morbidity. Ensure that multidisciplinary teams are in place to deliver the required level of rehabilitation in intensive care units and across the recovery pathway. Standardise the handover of rehabilitation needs and goals for patients as they transition from the intensive care unit to the ward, and ward to community services. Provide patients and their family/carers with clear information.
  2. Content Article
    This paper identifies some of issues around transitions of care when a patient leaves an intensive care unit (ICU) for ‘a general medical ward (or other de-escalated care settings, such as a step-down unit) for observation, treatment, and discharge planning.’ The authors describe a checklist to support safe ICU transfers of patients to medical wards or step-down units.  The proposed 7-step checklist has the mnemonic SIMPLER: Stable vital signs Intact aeration Medications reviewed Prepared psychology Lingering catheters Extreme laboratory findings, and Return plans. The authors state: "The first 3 steps are prerequisites in a medical ward and denote the importance of stable vitals signs, intact aeration, and a diligent medication check. The next 3 steps are priorities in the ICU and involve determining patient expectations, managing catheters or other devices, and reviewing laboratory results. The final step concerns contingency plans for unforeseen deteriorations and goals of care."
  3. Content Article
    A new issue brief from the Agency for Healthcare Research and Quality (AHRQ) examines the unique challenges of studying and improving diagnostic safety for children in respect to their overall health, access to care and unique aspects of diagnostic testing limitations for multiple paediatric conditions. The issue brief features approaches to address these challenges cross the care-delivery spectrum, including in primary care offices, emergency departments, inpatient wards and intensive care units. It also provides recommendations for building capacity to advance paediatric diagnostic safety. 
  4. Content Article
    The extent to which postintensive care unit (ICU) clinics may improve patient safety for those discharged after receiving intensive care remains unclear. This observational cohort study from Karlick et al., conducted at an academic, tertiary care medical centre, used qualitative survey data analysed via conventional content analysis to describe patient safety threats encountered in the post-ICU clinic. For 83 included patients, safety threats were identified for 60 patients resulting in 96 separate safety threats. These were categorised into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviours (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). Of the 96 safety threats, 41% were preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable. Nearly 3 out of 4 patients within a post-ICU clinic had an identifiable safety threat. Medication errors and delayed medical follow-up were the most common safety threats identified; most were either preventable or ameliorable.
  5. Content Article
    Patient safety incidents, including medical errors and adverse events, frequently occur in intensive care units, leading to a significant psychological burden on healthcare professionals. This burden results in second victim syndrome, which impacts the psychological and psychosomatic wellbeing of these staff members. This systematic review and meta-analysis aimed to examine the occurrence of second victim syndrome among intensive care unit healthcare workers, including the types, prevalence, risk factors and recovery time associated with the condition.
  6. Content Article
    Between 2009 and 2010, 48 year-old David Richards was admitted to intensive care during the ‘swine flu pandemic’. He spent six weeks in an intensive care unit (ICU), first on mechanical ventilation and later receiving extra-corporeal membrane oxygenation (ECMO) treatment. He recovered and became a survivor of severe acute respiratory distress syndrome (ARDS). During his 50 days in intensive care, David's former partner Rose kept an ‘ICU diary’. Rose recorded clinical updates as well as conversations with relatives and staff who were by David's bedside. In this article, David describes how important this diary has been to him understanding and processing his experience. It forms a record not just of procedures, treatments and clinical signs but of how he reacted, how he appeared to feel and how he tried to communicate during a time that were permeated by delirium.
  7. Content Article
    In anticipation of an increase in patients requiring a temporary tracheostomy due to the huge surge in patients placed on ICU ventilation at the peak of the COVID-19 pandemic, the NHS England National Patient Safety Team launched a National Patient Safety Improvement programme to rapidly support the NHS to provide safe tracheostomy care. Tracheostomy is a procedure to provide an artificial airway to assist breathing. A small surgical opening is made through the front of the neck into the windpipe and a curved plastic tube, known as a tracheostomy tube, is placed through the hole allowing air to flow in and out of the windpipe. There are various reasons why someone might need a tracheostomy. The commonest reasons are due to a blockage of the normal air passages (nose and mouth or at the back of the throat) or because a patient needs help from a ventilator for more than a few weeks. Previous research showed up to 30% (nearly one in three) patients receiving tracheostomy care have been found to suffer from avoidable harms related to lack of equipment, staff training, and/or limited infrastructure. During the pandemic this risk increased as patients with temporary tracheostomies were managed in makeshift ICUs or ward areas, and by staff who may not be familiar with the key principles to keep these complex and vulnerable patients safe. To support staff to keep tracheostomy patients safe at this challenging time, the National Patient Safety Improvement Programme expanded the work of the Improving Tracheostomy Care (ITC) project, that had been working with 20 NHS sites between 2016 and 2019; and commissioned the Academic Health Science Network’s (AHSN) 15 Patient Safety Collaboratives to rapidly deliver safety interventions across 180 NHS hospital sites in England. Central to this was the roll out of the three safety specific strategies (interventions) from the ITC programme: Standardised tracheostomy care bundles – evidence-based practices that are grouped together to encourage the consistent delivery of safe care. Bedhead signs – providing specific key information about the patient’s tracheostomy, along with details of what staff should do in an emergency and who to call for help. Standardised bedside and ward tracheostomy equipment – ensuring emergency equipment needed to manage a blocked or displaced tube was immediately available at all times, and accompanied the patient wherever they went during their hospital stay A ‘Safer Tracheostomy Care – a toolkit for healthcare staff’ was also developed by a multi-disciplinary team to further support healthcare staff.
  8. Event
    The countries focus on critical care services in England has increased because of COVID-19. A significant proportion of hospitalised patients with COVID-19 require help with breathing, including mechanical ventilation and other services critical care staff and units provide. Delivering sufficient critical care capacity goes beyond physical infrastructures – such as having more beds and equipment – and requires sufficient numbers of trained and available staff. The NHS ICU Virtual Summit: Future-Proofing Critical Care conference aims to celebrate the current efforts of ICU staff, in this time of unprecedented strain, via best practice and practical insight. We will also take a look at some key areas of potential improvement including: Understanding intensive care staffing, occupancy and capacity. Infection control. Crisis management and emergency preparedness. Clinical Information Systems. NHS staff and services will continue to be tested to their limits over the coming months, this short but high-value session aims to bring peers together from across the UK to share best practice and outcomes. Register
  9. Event
    A Westminster Health Forum policy conference with: Dr Clifford Mann, National Clinical Director, Urgent and Emergency Care, NHS England and NHS Improvement Dr Katherine Henderson, President, Royal College of Emergency Medicine Jessica Morris, Nuffield Trust; Dr Nick Scriven, The Society of Acute Medicine; Sandie Smith, Healthwatch Cambridgeshire and Peterborough; and Deborah Thompson, NHS Acute Frailty and Ambulatory Emergency Care Networks and NHS Elect Delegates will discuss key developments and challenges in the context of service changes in response to the COVID-19 pandemic, and the ongoing implementation of the NHS Long Term Plan. Register
  10. News Article
    "Traumatised" and "exhausted" medical staff need time to recover before tackling an NHS backlog, says the group representing hospitals in England. Many staff could resign if their wellbeing is not factored into plans to cut waiting lists, NHS Providers said. The number of people waiting more than a year for surgery rose 1,613 to 192,000 during the Covid pandemic. NHS Providers said demand for hospital beds is easing, but the pressure on intensive care units is still intense. NHS Providers estimates that it is going to be at least a month before the NHS gets back to normal winter pressures, and trusts are concerned about the transition into the next phase of the pandemic. Critical work that has been postponed, including a small number of urgent cancer cases, will be a priority, but there remains a need to tackle a wider backlog of routine operations alongside the vaccination programme. NHS Providers said trusts will work as fast as possible to tackle the backlog, but leaders cannot do so at the expense of staff burnout. Last month, a study suggested that many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead". Read full story Source: BBC News, 1 February 2021
  11. News Article
    COVID-19 patients in England's busiest intensive care units (ICUs) in 2020 were 20% more likely to die, University College London research has found. The increased risk was equivalent to gaining a decade in age. By the end of 2020, one in three hospital trusts in England was running at higher than 85% capacity. Eleven trusts were completely full on 30 December, and the total number of people in intensive care with Covid has continued to rise since then. The link between full ICUs and higher death rates was already known, but this study is the first to measure its effect during the pandemic. Tighter lockdown restrictions are needed to prevent hospitals from being overwhelmed, says study author Dr Bilal Mateen. Researchers looked at more than 4,000 patients who were admitted to intensive care units in 114 hospital trusts in England between April and June last year. They found the risk of dying was almost a fifth higher in ICUs where more than 85% of beds were occupied, than in those running at between 45% and 85% capacity. That meant a 60-year-old being treated in one of these units had the same risk of dying as a 70-year-old on a quieter ward. The Royal College of Emergency Medicine sets 85% as the maximum safe level of bed occupancy. However, the team found there was no tipping point after which deaths rose - instead, survival rates fell consistently as bed-occupancy increased. This suggests "a lot of harm is occurring before you get to 85%". Read full story Source: BBC News, 14 January 2021
  12. News Article
    More than a third of critical care units in the East of England are either at or have exceeded their maximum surge capacity, information leaked to HSJ reveals, and all but one are above their normal capacity. Data from the region’s critical care network shows that as of 11 January, seven of the region’s 19 critical care units were either at 100% of, or had exceeded, what is known as ”maximum safe surge” capacity. This represents the limit of safe care, mostly based on available staffing levels. The units have opened more beds, but they require dilution of normal staffing levels. Across the East of England, 482 of the region’s current 491 intensive care beds, after the opening of surge capacity, were occupied. This included 390 patients in intensive care with confirmed covid-19, six with suspected covid and 86 non-covid patients. It gives a regional occupancy rate of 91 per cent against total “safe surge” capacity. Published government figures show the rapid increase in demand for intensive care in the East of England in the last two weeks — the number of patients with covid in mechanical ventilation beds is more than double what it was just after Christmas. Read full story (paywalled) Source: HSJ, 11 January 2021
  13. News Article
    "There can be no debate: this is now much, much worse than the first wave", says a NHS consultant. "Truly, I never imagined it would be this bad. Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant. The patients are younger this time around too, and there are so many of them. They are sick. We are full." Read full story Source: The Guardian, 7 January 2020
  14. News Article
    For the first since April the UK has recorded more than 1,000 daily Covid-related deaths – one of the highest figures of the pandemic. Right now, London is at the epicentre of this crisis. Hospitals now have more Covid patients being admitted every day than they did at the peak in April. Many doctors and nurses say they're reaching breaking point. The BBC's medical editor Fergus Walsh filmed inside the intensive care unit at London's University College Hospital, which is one of the busiest in the capital. View video Source: BBC News, 6 January 2021
  15. News Article
    London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
  16. News Article
    London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned. The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity. More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice. On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen. Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%. Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running. A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.” Read full story Source: The Independent, 17 December 2020
  17. News Article
    Across Britain, intensive care nurses and doctors are being pushed to their limits as they try to save lives from coronavirus. During 12-hour shifts in sweltering conditions, they are faced with technical and emotional challenges that many have never faced as they tackle a virus that has swept across the globe in a matter of days, threatening to kill tens of thousands in the UK. Britain has yet to even hit the peak of infections, but intensive care specialists are already asking how long they can keep working relentlessly. “We are trained for and used to dealing with difficult and emotional scenarios, but this is like a major incident that never ends,” says critical care nurse Karin Gerber. As an advanced nurse practitioner in critical care outreach, the 47-year-old sees patients in hospital who are getting sicker and may need to be admitted to intensive care. She says she has never seen anything “at this intensity”. The Royal London Hospital is at the forefront of the capital’s fight against the virus and has created more than 200 extra beds at its Whitechapel site in east London. They are filled with COVID-19 patients. Simon Richards, senior charge nurse at the Royal London’s critical care unit, tells The Independent: “In 20 years as a nurse this situation is by far the worst I have ever seen and totally unexpected, but the team spirit that people have shown has been amazing. “It’s extremely difficult, we are working so hard. The whole team is being pushed to their limit and you do wonder how long can this be sustained for? I wish we could see light at the end of the tunnel.” Read full story Source: The Independent, 24 November 2020
  18. News Article
    A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say. Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care. The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year. “We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.” Read full story Source: The Guardian, 20 November 2020
  19. News Article
    Nurses will be allowed to look after two critically ill COVID-19 patients at the same time after NHS bosses relaxed the rule requiring one-to-one treatment in intensive care as hospitals come under intense strain. NHS England has decided to temporarily suspend the 1:1 rule as the number of people who are in hospital very sick with Covid has soared to 11,514, of whom 986 are on a ventilator. The move comes amid concern that intensive care units, which went into the pandemic already short of nurses, are being hit by staff being off sick or isolating as a result of Covid. It follows a warning last week by Prof Chris Whitty, England’s chief medical officer, that the Covid resurgence could overwhelm the NHS. Dr Alison Pittard, the dean of the Faculty of Intensive Care, which represents doctors in ICUs, welcomed the shift to a more “flexible” nurse/patient staffing ratio in critical care. But she said it must be used only for as long as the second wave is putting units under serious pressure. “Covid has placed the NHS, and critical care in particular, in an unenviable position and we must admit everyone for whom the benefits of critical care outweigh the burdens. This means relaxing the normal staffing ratios to meet this demand in such a way that delivers safe care, but also takes account of the impact this may have on staff health and wellbeing." “The 1:2 ratio is a maximum ratio, to be used only to support Covid activity, [and] not for planned care, and is not sustainable in the long term. This protects staff and patients”, she said. Read full story Source: The Guardian, 8 November 2020
  20. News Article
    Several hospitals in the north of England are already at full capacity and may have to start moving patients to other regions, doctors have warned. Consultants fear that if Covid infection rates do not begin to fall significantly the NHS will be overwhelmed in less than a month from now. Members of the British Medical Association have reported that Intensive Care Units (ICU) in a number of regions, including Manchester, Liverpool and Hull, are close to capacity as the number of people hospitalised with COVID-19 continues to grow. Dr Vishal Sharma, chairman of the BMA’s consultants committee, told The Telegraph: “Capacity in the north of England is at the limits and in some places above the limit. Our next concern is ICU capacity, which is always tight at this time of year, even without Covid.” Dr Sharma said some general ward beds could be adapted to provide intensive breathing support for Covid patients, and the re-opening of Manchester’s Nightingale Hospital may also take the pressure off ICU departments. But more radical steps may have to be taken if numbers of hospitalised patients continue to rise. “We may have to move patients around the country to create extra capacity, but if the whole country starts to struggle things will get very difficult." Read full story Source: The Telegraph,
  21. News Article
    As hospitalisations and intensive care admissions surge around the country, new figures indicate coronavirus patients in critical care have a better survival rate now than when the pandemic first began. The latest report from The Intensive Care National Audit and Research Centre (ICNARC) into critical care for England, Wales and Northern Ireland looks at patients admitted to intensive care up until 31 August and those admitted from 1 September. The data shows that on average, 39% of critical care coronavirus patients died up until the end of August while less than 12% have died since September. The proportion of patients who died after being admitted to critical care fell by almost a quarter from the peak and as much as half in hospitals overall. However, the Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard, told the BBC that the difference may be attributed to an insufficient amount of time having passed which impedes an accurate and longterm patient assessment, as some remain in hospital. Meanwhile, scientific advisors continue to warn that the next few weeks are critical for regulating hospital admissions. Read full story Source: The Independent, 18 October 2020
  22. 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
  23. News Article
    Covid survivor Tam McCue is one of the lucky ones. Earlier in the year he was in intensive care in the Royal Alexandra Hospital in Paisley where he had been on a ventilator for nearly two weeks. At one point Mr McCue, who could barely speak, didn't think he would live. Fast forward five months and Mr McCue, of Barrhead, East Renfrewshire, is back from the brink. He became desperately ill but, thankfully, it only went as far as his lungs. With coronavirus some patients have have suffered multiple organ failure which also affected their heart, kidneys, brain and gut. Mr McCue describes his recovery as a "rollercoaster". He added: "It's a slow process. You think you can do things then the tiredness and fatigue sets in." He said: "It lies in the back of your mind. As years go on, how are you going to be? Is it going to get you again? It does play on you. It definitely does." As part of his recovery Mr McCue is attending the Ins:pire clinic online. It is normally a face-to-face rehabilitation clinic which involves multiple specialties, including pharmacists, physiotherapists and psychologists. Mr McCue is one of the first Covid survivors to take part in the five-week programme, which started earlier this month. Read full story Source: BBC Scotland News, 29 September 2020
  24. News Article
    Hospitals have been warned hundreds of ventilators used to keep sedated patients alive are at risk of suddenly shutting down because of a fault, in some cases without warning. The Medicines and Healthcare products Regulatory Agency, which said there were approximately 303 Philips Respironics V60 ventilators used in the UK, has warned hospitals over a delay in replacement parts arriving in the UK to fix the problem. It has issued a safety alert to hospitals to make them aware of the increased risk. The regulator said it had received one report of a ventilator suddenly shutting down but said there was no report of any injury to patients. Read full story Source: The Independent, 23 September 2020
  25. News Article
    "I'm not sure I want to be a nurse anymore," she tells me. "I've seen more people die in the past two months than in the whole six years." Some 70% of health workers dealing with COVID-19 in Italy's hardest-hit areas are suffering from burnout, a recent study shows. "This is actually the hardest moment for doctors and nurses," says Serena Barello, the author of the study. Read story Source: BBC News, 26 May 2020

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