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Event
The NHS ICU Virtual Summit: Future-proofing critical care
Sam posted a calendar event in Community Calendar
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 -
News ArticleCOVID-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
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News Article
Third of region’s ICUs exceed ‘maximum safe capacity’
Patient Safety Learning posted a news article in News
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 -
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
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ICU hospital staff: 'Scared, sad, petrified, worried'
Patient Safety Learning posted a news article in News
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 -
News ArticleLondon’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
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News ArticleLondon’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
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EventA 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
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News Article
The battle for survival in Britain's intensive care units
Patient Safety Learning posted a news article in News
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 -
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Rheumatoid arthritis drug appears to help Covid patients in ICU
Patient Safety Learning posted a news article in News
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 -
Content ArticleDefinition The authors of this paper have developed a definition, including both a short-form and a long-form definition. Here is the short-form and the long-form can be found in the full paper: Patient and family* engagement in the ICU is an active partnership between health professionals and patients and families working at every level of the healthcare system to improve health and the quality, safety, and delivery of healthcare. Arenas for such engagement include but are not limited to participation in direct care, communication of patient values and goals, and transformation of care processes to promote and protect individual respect and dignity. PFE comprises five core concepts: Collaboration, Respect and Dignity, Activation and Participation, Information Sharing, and Decision Making. Brief summaries of the core concepts are presented in Table 1 and depicted visually in Figure 1. *Family is broadly defined to include all the individuals whom the patient wants involved in his/her care, regardless of whether they are related biologically, legally, or otherwise; if the patient is noncommunicative, health professionals will make their best effort to identify and include the individuals whom the patient would want involved in his/her care.
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News Article
NHS England suspends one-to-one nursing for critically ill Covid patients
Patient Safety Learning posted a news article in News
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 -
Content ArticleThis poster was created by the Royal Free Nursing team on the intensive care unit. It demonstrated how they reduced turnover of staff on the unit by implementing 'Joy in Work'.
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News ArticleSeveral 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,
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Coronavirus: Survival rate of intensive care patients improving, data suggests
Patient Safety Learning posted a news article in News
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 -
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Liverpool intensive care units '90% full' as city braces for second wave
Patient Safety Learning posted a news article in News
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 -
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Covid ICU survivor: 'I have come out the other end'
Patient Safety Learning posted a news article in News
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 -
News ArticleHospitals 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
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Community PostDuring the COVID pandemic, it was clear that Emergency Departments across the UK needed to adapt and quickly, with my trust not exempt from this. We have increased capacity, increased our nursing and doctors on the shop floor, obviously with nurse in charge being responsible for all areas. We have different admission wards in terms of symptoms that the patient has, but also have a different type of flow, which i am getting my head around to be able to share I have seen departments split into 2 and various other ideas coming out from various trusts. Which got me thinking about patient safety and how well this is managed. So.... How is your department responding to the pandemic? Do you have any patient safety initiatives as a result of the response? Is there a long term plan? The reason why i am asking this, is so we can share practice and identify individual trust responses.
