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Found 43 results
  1. 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
  2. News Article
    Dozens of intensive care units are still running well over their normal capacity – in some cases more than double – weeks after the peak of demand, figures seen by HSJ reveal. It contrasts with the picture painted at some government coronavirus press conferences that there is huge “spare capacity” in critical care and has been throughout the outbreak, with Downing Street charts putting England-wide occupancy at around 20% currently. The government’s assertions include the additional “surge” capacity which was hurriedly established at the start of the outbreak. But intensive care staff have been frustrated by this being labelled spare capacity, when the number of patients being treated is still well above normal levels. In addition, the ongoing reliance on keeping surge beds open – with ICUs still spilling over other spaces and calling on staff and equipment from other services – will limit hospitals’ ability to resume normal care, such as planned surgery. Steve Mathieu, a consultant in intensive care medicine in the south of England, said: “The majority of ICUs will currently be operating at over 100 per cent capacity and typically somewhere around 130-150 per cent, although there is significant regional variation". “There are uncertainties whether this will now represent the ‘new normal’ for the foreseeable future and there is a national need to plan for further potential surges in activity requiring more critical care demand." Read full story Source: HSJ, 21 May 2020
  3. News Article
    Intensive care units (ICU) will be advised how to improve their staffing-to-patient ratios shortly as the number of patients admitted to hospital with COVID-19 falls across the country. In expectation that the pandemic would put intense pressures on ICUs, staff ratios were relaxed. NHS England told trusts to base their staffing models on one critical care nurse for every six ICU patients, supported by two non-specialist nurses, and one senior ICU clinician for every 30 patients, supported by two middle-grade doctors. Before the pandemic, guidance from the Faculty of Intensive Care Medicine recommended a ratio of one non-specialist nurse per patient. For senior clinicians the ratio was 1:10 New guidance, expected as early as next week, will encourage trusts to reduce the number of patients per ICU specialist nurses and senior clinicians on a localised basis as part of “transitional arrangements” aimed at moving staffing models back towards normal standards of care, HSJ has been told. The new guidance, drawn up by NHS England, the Faculty of Intensive Care Medicine and the British Association of Critical Care Nurses, will give trusts recommended staffing ratios based on the occupancy rates of their ICUs. It will tell trusts the existing ratios should be applied if their ICUs are running at four times their normal capacity. For ICUs running at double capacity, this ratio would be reduced to 1:2 for ICU nurses, and 1:15 for senior clinicians. Read full story Source: HSJ, 8 May 2020
  4. News Article
    Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital. Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”. He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.” It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said. Read full story Source: HSJ, 28 April 2020
  5. News Article
    Intensive care units across the country are running out of essentials, including anaesthetics and drugs for anxiety and blood pressure, after a “tripling of demand” sparked by the coronavirus pandemic. Six senior NHS doctors working on the front line, and drugs industry sources, say that the health service is running out of at least eight crucial drugs. Hospitals in London, Birmingham and the northwest of England have been especially badly hit. Doctors said they were being forced to use alternatives to their “drug of choice”, affecting the quality of care being provided to COVID-19 patients. They also warned that some second-choice drugs might be triggering dangerous side effects such as minor heart attacks. Ron Daniels, an intensive care consultant in the West Midlands, said the shortages had become “acute” already. “We don’t know what we’re going to run out of next week,” he said. “Safety isn’t so much the issue — it’s quality. It may be that we’re subjecting people to longer periods of ventilation than we would normally because the drugs take longer to wear off.” Daniels added that some of the “second-line drugs” being used might be challenging to a patient’s heart: “We might be causing small heart attacks or subclinical heart attacks.” Ravi Mahajan, president of the Royal College of Anaesthetists, said work was being carried out to “preserve” key drugs for those most in need. Read full story (paywalled) Source: The Times, 26 April 2020
  6. News Article
    A coronavirus patient’s terrifying hospital experience inspired an NHS doctor to create a flashcard system to improve communication with medical staff wearing face masks. Anaesthetist Rachael Grimaldi founded CARDMEDIC while on maternity leave after reading about a COVID-19 patient who was unable to understand healthcare workers through their personal protective equipment (PPE). Her system enables medical staff to ask critically ill or deaf coronavirus patients important questions and share vital information on digital flashcards displayed on a phone, tablet or computer. The idea went from concept to launch on 1 April in just 72 hours and is now being used by NHS trusts and hospitals in 50 countries across the world. Read full story Source: The Guardian, 25 April 2020 Read the 'Story behind CARDMEDIC', written by Rachael for the hub
  7. Content Article
    I am an NHS anaesthetist at Brighton and Sussex University Hospitals NHS Trust, on maternity leave (with three children under the age of 4 years), and currently stuck abroad in the US. Unable to be patient-facing during the COVID-19 pandemic, I have had to re-evaluate my initial plans to return to work. I have felt desperate to do something to help, and while keeping up with the news I was inspired by an article I read about a critically ill intensive care patient who was terrified when he couldn’t understand what the healthcare team were saying to him through their PPE (face masks, visors, hoods, etc). PPE creates a barrier to communication. So much is lost through this barrier. Not only verbal communication, but also non-verbal cues, which form the basis of the majority of communication – the ability to lip read for those that rely on it and the human connection behind the mask. As such, there is a significant risk of miscommunication of vital information between the patient and healthcare provider, presenting a considerable patient safety issue. What started out as a simple thought, “would healthcare staff be able to write down what they need to say on a piece of paper and show it to the patient?”, within 72 hours turned into an A–Z index of digital flashcards covering a wide range of topics, and www.cardmedic.com was launched. A free online resource for all to use, CARDMEDICTM launched on 1 April 2020. Prior to being shared on national news platforms, the site already had over 8000 users in 50 countries across 6 continents in just over 3 weeks, including across Europe, Australia, New Zealand, United States, Canada, Asia and Africa. It was shared by the Defence Medical Services to over 70 senior clinicians across all specialties in multiple Trusts across the UK. Since being featured in The Guardian and various other media outlets, the site has now had over 10,000 visits and 60,000 page views in less than 8 hours! I have been inundated with support, positive feedback and offers of help ranging from translation to illustrations and more. CARDMEDICTM is simple to use. Healthcare providers can access www.cardmedic.com/flashcards either on their institution’s or their patient’s smart phone, tablet or desktop. Choose the flashcard you would like to talk to the patient about and display it on the screen to the patient. Just ensure the website is displayed in the relevant language, there are 10 to choose from at the moment (thanks to Weglot) – this option is currently at the bottom right hand side of the page. If your patient is too unwell or unable to read, or partially sighted or blind, there is also a read-aloud option (thanks to SiteSpeaker) – choose the blue “play” button at the top right of the screen. Devices can be placed in freezer bags that are compatible with gloves and can be disposed of between patients, although we are aware of the environmental impact of this. Alternatively, some places have devices that they disinfect by wiping clean between patients. For those who prefer a paper-based approach, the cards can be printed and laminated; write-on, wipe-off. We are working on making these available as downloadable PDFs. With the re-deployment of vast numbers of healthcare and allied healthcare professionals, together with those returning to practice, there are a large number working outside their usual realm of clinical practice. This presented a further issue; staff may feel uncertain of how to talk to patients about certain aspects of their care in simple language if it is an area they are not familiar with working. The flashcards can also act as a reminder or prompt in these circumstances and another layer of maintaining patient safety. We have also just launched a free app on 25 April, compatible with android and iOS/Apple, improving accessibility for those with difficult internet access and ease of access for all..A huge thanks to Phil at A Million Monkeys for working tirelessly over the last couple of weeks on this. The app should not only improve accessibility for those in areas with little or no internet access, but also provide an immediately available source of flashcards that will be continually updated, without having to repeatedly download new versions from the app store. Based upon my training in anaesthetics and, as a part of this, experience in critical care, I wrote the majority of the CARDMEDICTM content. I have had significant contribution both in terms of content and resources from specialist colleagues in critical care nursing, end of life and palliative care, radiography, DNAR, obstetrics, midwifery, speech and language therapists and learning disability nurses, with more to come. Whilst what we have prepared is not professing to be a “gold standard” in communication, it is based upon a wealth of combined experience, knowledge and an acceptable standard in clinical practice. There is much planned in way of development, in part shaped by the feedback we have received. For example, we are collaborating with Signly on integrating British Sign Language videos and also working on integrating illustrations to improve accessibility for users. I am delighted to have Scarlett Brandley, a Leeds University Medical School student, spending her elective with me working on it. Some incredible suggestions have also been put forward about using it in refugee camps in Greece, Iran and Afghanistan. CARDMEDICTM has been developed through a combination of extreme generosity of colleagues, friends, family, contacts, word of mouth and Twitter, as well as very much burning the candle at both ends seven days a week. When I started this, I thought I would share the site with a few friends and colleagues and it would hopefully help make a difference to a few patients. I never envisaged it would have grown so rapidly and at such pace. I am so overwhelmed by the time, advice, services donated free of charge from so many different people – organisations, colleagues, friends and family. There are too many people to thank here! To mention a few – Patient Safety Learning have been championing it and have been a great source of support. My friends and colleagues at Brighton and Sussex University Hospitals NHS Trust and the University of Brighton have been incredibly supportive and proactive – I am very grateful. The Department for International Trade has been fantastic and introduced me to so many different contacts across a wide range of organisations, including Grow Global and Signly. A Million Monkeys has worked tirelessly on developing the app. The Defence Medical Services have shared it across the UK. The Academic Health Sciences Network (AHSN) have also been a really useful resource, especially with advice on possible funding streams. Dr Andy Tagg at Don’t Forget the Bubbles in Australia has been brilliant and we are looking forward to working together, along with Jane Stokes, to translate it into a further 15–20 languages. Having never been on Twitter before, the networking opportunities have been phenomenal and so many people have come forward too, to offer their time and expertise with various clinical sections of the site. I could go on! I am humbled to think my idea could have such far reaching purpose and value as this. It has been and continues to be, an enormous team effort to pull this together. We have applied for government funding and are yet to hear back. If this doesn’t come through, I am going to take the anaesthetics department at Brighton and Sussex University Hospitals NHS Trust up on their incredible offer of financial start-up support to aid further development, as well as a private donor up on their unbelievably generous offer to pay for the app development. All else has been without funding. It is so important for this to remain free for the end users: the patients and the staff. We are constantly looking to develop and improve. It is essential this works on the frontline and we are very grateful for your thoughts and feedback. If you have a moment, please either contact us via the website (www.cardmedic.com/contact) or via Twitter (@cardmedic).
  8. Content Article
    This website provides nformation, guidance and resources supporting the understanding and management of coronavirus (COVID-19), iincluding: airway management for adults and children obstetric management critical care management cross skilling podcasts and webinars PPE drug management.
  9. News Article
    A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”. In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites. The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19. “This means that we currently do not have enough space for patients requiring critical care. “As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site” Read full story (paywalled) Source: HSJ, 20 March 2020
  10. News Article
    Matt Morgan, an intensive care doctor, describes in this Guardian article how his ICU are preparing for the coronavirus crisis. "ICUs are as prepared as they can be. Locally business as usual has made way for preparations for caring for high numbers of patients. We are finding every ventilator we may have and identifying every suitably qualified member of staff. We will work together to fill gaps as best we can. There’s a sense of anticipation about what the next eight, 10, 12 weeks are going to bring in terms of work. Anyone who works in healthcare is also a mum, dad, daughter, brother, son. We want to give everything to saving lives and work and care, but equally we’re thinking about the logistics of personal lives and elderly relatives too." Matt says his worst nightmare is having insufficient workforce and equipment to meet patient needs. Whether or not that will come to fruition is tough to predict. He also says that his ICU has a psychologist who’s doing a huge amount of thinking about putting in place wellbeing resources for staff who might be in moral distress after having to prioritise one patient over another. "If there are 500 patients and only 200 ventilators then that’s when we need national guidance from the government and other bodies. It can’t be up to individual doctors. The age of playing God is long behind us. The question is who should we be making decisions with: the public, government or within the profession?" Read full story Source: The Guardian, 13 March 2020
  11. News Article
    NHS hospitals have been told to expect a “several-fold” increase in demand for intensive care beds during a serious coronavirus outbreak. Professor Keith Willett, NHS England’s incident director for the coronavirus outbreak, told a secret briefing of chief nurses from across the NHS that they needed to prepare now for the unprecedented demand which could overwhelm existing critical care services. Sources who were in the briefing told The Independent Prof Willett warned the demand was likely to be not just double but “several fold” the existing 4,000 intensive care beds in the NHS. Prof Willett said the NHS will also be holding large-scale simulations next week for an expected coronavirus surge in an effort to “stress test the system” ahead of rising cases of infection. If the predictions are right the NHS will likely be forced to cancel large numbers of operations and re-deploy nurses and doctors. Read full story Source: The Independent, 12 March 2020
  12. Content Article
    Implications While this study shows that those referring patients to ICU could benefit from greater support, the decision support tool trialled in this study would need some adaptation to fit the time-pressured realities of the users. The process did seem to help clinicians articulate and communicate their reasoning for admission. Perhaps, as the authors say, if the tool were to be integrated into existing systems the perceived additional workload may be diminished. Another not insignificant finding is that although clinicians stated they valued patient’s wishes, in some cases there was a lack of patient and family involvement.
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