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Found 20 results
  1. 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. 
  2. Content Article
    This study from Jalilian et al., published in the BMJ, evaluated the length of stay difference and its economic implications between hospital patients and virtual ward patients. It found that the use of a 40-bed virtual ward was clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day. However, the cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.
  3. News Article
    Researchers have found the costs of treating patients in a 40-bed virtual ward were double that of traditional inpatient care. The study’s authors said the findings should raise concerns over a flagship NHS England policy, which has driven the establishment of 10,000 virtual ward beds. Virtual wards, sometimes described as “hospital at home”, are cited as a safe way to reduce pressure on hospitals, by reducing length of stay and enabling quicker recovery. The study at Wrightington Wigan and Leigh Teaching Hospitals, in Greater Manchester, found a clear reduction in length of stay but also found higher rates of readmission. The authors said this led to additional costs, with the cost of a bed day in the virtual ward estimated at £1,077, compared to £536 in a general inpatient hospital bed. “This raises concerns [over] the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management. This evidence should be taken into consideration by [the] NHS in planning the next large deployment of virtual wards within the UK… “Virtual wards must be cost effective if they are to replace traditional inpatient care, the costs must be comparable or lower than the costs of hospital stay to be economically sustainable in the medium to long terms.” To break even, the paper said the virtual ward would need to double its throughput, but warned this would risk lowering the standard of care. Read full story (paywalled) Source: HSJ, 25 January 2024
  4. News Article
    The scale of the crisis in social care is laid bare as figures show that dementia patients occupy a quarter of all beds in the NHS. People living with the disease often go into hospital after falls or infections as well as for acute medical or surgical problems. Dementia patients often experience longer hospital stays than the average patient and can be delayed leaving wards due to a shortage of care in the community. At any one time in the NHS, one in four hospital beds are occupied by people living with dementia, according to the National Institute for Health and Care Excellence, which says stays on wards can trigger distress, confusion and delirium for patients. Doctors must carry out a discharge assessment of patients to ensure they are healthy before they can leave hospital. Medics assess a dementia patient’s care needs outside of hospital and discharge can be delayed if these are deemed not adequate. Demand for social care continues to rise as the population grows older but there is a shortage of workers in the sector. Skills for Care estimated that, in 2022/23 an average of 9.9 per cent - or 152,000 - roles in adult social care in England went unfilled. This was the equivalent to 152,000 vacancies - down by 11,000 from the previous year, although vacancies remain high compared to the wider UK economy. Services are so overstretched that people are left struggling without vital support to carry out everyday tasks in their own homes, and lives are being blighted. Read full story Source: The Independent, 14 January 2024
  5. News Article
    An algorithm which can predict how long a patient might spend in hospital if they’re diagnosed with bowel cancer could save the NHS millions of pounds and help patients feel better prepared. Experts from the University of Portsmouth and the Portsmouth Hospitals University NHS Trust have used artificial intelligence and data analytics to predict the length of hospital stay for bowel cancer patients, whether they will be readmitted after surgery, and their likelihood of death over a one or three-month period. The intelligent model will allow healthcare providers to design the best patient care and prioritise resources. Bowel cancer is one of the most common types of cancer diagnosed in the UK, with more than 42,000 people diagnosed every year. Professor of Intelligent Systems, Adrian Hopgood, from the University of Portsmouth, is one of the lead authors on the new paper. He said: “It is estimated that by 2035 there will be around 2.4 million new cases of bowel cancer annually worldwide. This is a staggering figure and one that can’t be ignored. We need to act now to improve patient outcomes. “This technology can give patients insight into what they’re likely to experience. They can not only be given a good indication of what their longer-term prognosis is, but also what to expect in the shorter term. “If a patient isn’t expecting to find themselves in hospital for two weeks and suddenly they are, that can be quite distressing. However, if they have a predicted length of stay, they have useful information to help them prepare. “Or indeed if a patient is given a prognosis that isn’t good or they have other illnesses, they might decide they don’t want a surgical option resulting in a long stay in hospital.” Read full story Source: University of Plymouth, 30 March 2022
  6. News Article
    Doctors and health service providers welcomed publication of an NHS strategy for managing demand ahead of another busy winter for health and social care, but said it failed to address underlying problems with the system. In a letter to the heads of NHS trusts and integrated care boards, NHS England chiefs said they had begun planning for capacity and operational resilience in urgent and emergency care ahead of "significant challenges" during the coming months. The British Medical Association (BMA) said the strategy was a "step in the right direction", but "lacks detail", while the Royal College of Emergency Medicine (RCEM) said it amounted to little more than "a crisis mitigation plan". The package of measures included creating the equivalent of 7000 extra general and acute beds through a mix of new physical beds, scaling up 'virtual' beds, and "improvements in discharge and flow". The letter acknowledged that there was "a significant number of patients spending longer in hospital than they need to" and that whilst "the provision of social care falls outside of the NHS’s remit, the health service must ensure patients not requiring onwards care are discharged as soon as they are ready and can access services they may need following a hospital stay." Read full story Source: Medscape, 15 August 2022
  7. News Article
    Older and overweight patients are making it harder to clear NHS surgery backlogs, anaesthetists have warned. New data reveal an “extremely worrying picture” of increasing age, rates of obesity and complexity of surgical patients across the UK, the Royal College of Anaesthetists said. The average age of patients requiring anaesthesia increased by 2.3 years, from 50.5 to 52.8, over the last decade, while their BMI also jumped from 24.9 (borderline normal/overweight) to 26.7 (overweight). The proportion of patients who are complex or have other comorbidities has also significantly increased, the study found. When patients are older, overweight and have other problems, this makes anaesthetic and surgical care more complicated and higher risk, the authors said. Managing these patients safely takes longer during surgery and can lead to slower recovery times, requiring more time in hospital. Read full story (paywalled) Source: The Telegraph, 2 March 2023
  8. News Article
    Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals. The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community. Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans. In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital. Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed. The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.” Read full story (paywalled) Source: HSJ, 22 February 2023
  9. News Article
    Extra beds squeezed into hospitals as part of winter planning are crowding out space for rehab, pushing up length of stay and knock-on costs, and increasing the chance of readmission, NHS leaders have been warned. Systems and trusts were encouraged to staff thousands of additional ward beds in the run-up to last winter to try to ease emergency care pressures, and government and NHS England have since asked for many of them to be kept open through the year. However, many of the additional beds are not in proper ward spaces, instead being located in gyms and other areas used for physiotherapy and other rehab. This followed on from some rehab areas already being lost during the pandemic, to be used for beds or storage. NHSE has sent out a warning about the issue, following a commitment by ministers earlier this year. However, senior figures in physio and older people’s care remain concerned the spaces will not be restored without checks and enforcement, especially as acute trusts remain under pressure to increase general bed space.
  10. Content Article
    Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Morgan et al. evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs.  They found that SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change.
  11. News Article
    One of the country’s most senior doctors has said he is “desperate” to keep his elderly parents out of hospital, which he said are like “lobster traps”. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said hospitals are easy to get into but hard to get out of. His comments come after figures showed the number of patients in hospital beds in England who no longer need to be there has reached a new monthly high. An average of 13,613 beds per day were occupied by people ready to be discharged from hospital in October. That was up from 13,305 in September and the highest monthly figure since comparable data began in December 2021, according to analysis by the PA news agency. In an interview with the Daily Mail, Dr Boyle said: “Hospitals are like lobster traps – they’re easy to get into and hard to get out of. “If social care was able to do its job in the way we want it to, these poor people wouldn’t be stranded in hospital. “I have elderly parents and I’m desperate to keep them out of hospital. “For someone who is frail, hospital is often a bad place for them. They’re being harmed by being in hospital.” Read full story Source: The Independent, 14 November 2022
  12. News Article
    A Guardian analysis has found that as many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go. Barry Long's 91-year-old mother has Alzheimer’s and was admitted to Worthing hospital on 30 May after a minor fall. She was a bit confused but otherwise unhurt, just a bit shaken. Whilst in hospital, she caught Covid and had to be isolated, which she found distressing, and became increasingly disoriented. She was declared medically fit to be discharged but no residential bed could be found for her. Then, in August, she was left unsupervised and fell over trying to get to the toilet and she fractured her hip, which required surgery. Her hip was just about healed when she caught her shin between the side bars and the frame of the bed, cutting her shin so badly that she is being reviewed by a plastic surgeon to see if it needs a skin graft. "Since the operation, my mum is pretty much bedbound and lives in a state of confusion and anxiety", says Barry. "Her physical health and mental wellbeing have deteriorated considerably in the almost five months she has spent in the care of the NHS. She spends all day practically trapped in bed, staring into space or with her eyes shut, just rocking to and fro. She has little mental stimulation." Read full story Source: The Guardian, 13 November 2022
  13. News Article
    People needing acute mental health treatment are being left in prison for extended periods, HSJ can reveal. Figures HSJ obtained under the Freedom of Information Act show that 3,111 patients were transferred from prisons to mental health facilities between 2018-19 and 2020-21. A total of 481 (15%) of the transfer took more than 14 days from the date the mental health casework section received an application for transfer to the date the transfer took place. Across these three years, 167 transfers (5%) took more than 28 days. The longest wait for transfer was 161 days, which happened in 2018-19. However, the average number of days taken to transfer a patient has remained consistent at between 10 and 11 days. Until the summer, NHS England’s guidance recommended a 14-day time limit for transfers of patients from prisons to mental health facilities. In June 2021, NHSE published new guidance which recommended a 28-day time limit between a person first being referred for inpatient assessment and being admitted to a mental health facility. The timeline, which consists of two sequential 14-day periods, says medical reports should be “completed to be sent to the [MHCS]” between days 15 and 25, while the MCHS should approve and issue a warrant and admission should take place before day 28. Sophie Corlett, of mental health charity Mind, said: “Nobody who has been assessed as needing specialist inpatient care should be left for extended periods of time in prison, as it’s a completely inappropriate setting for anyone in crisis… When people are a risk to themselves, it’s crucial there are enough staff and beds available to make sure they are cared for in a safe and therapeutic environment.” Bethan Roberts, British Medical Association forensic and secure environments committee interim chair, said: “A prisoner who is mentally unwell and cannot be adequately cared for in a prison should… be transferred to a forensic mental health unit as soon as possible." Read full story (paywalled) Source: HSJ, 1 December 2021
  14. Content Article

    Why I ‘walk on by’

    Anonymous
    I recently read the blog on the hub ‘Walk on by...’ by a junior doctor. What a fantastic doctor, if only we had more of these people in our healthcare service.  I wanted to respond to this blog by writing about my own experiences in ‘walking on by’. It’s been a difficult write as it has questioned my integrity, my motivation and my career.  
  15. Content Article
    A candid account from a healthcare professional on how it feels to have to tell a patient in intensive care that their treatment is to be delayed. Part of the Guardian newspaper's Blood, sweat and tears series.
  16. Content Article
    In this briefing, the Improvement Analytics Unit (a partnership between the Health Foundation and NHS England) identifies some early signals of changes in hospital use by vanguard care home residents in Wakefield, in order to inform local learning and improvement.
  17. Content Article
    Julie Carman was involved in a road traffic accident whilst on a cycling holiday, suffering injuries to her face, jaw and legs. After making a good initial recovery and expecting to be back at work within three months – three years later she is still having treatment having experienced two further emergency admissions to hospital due to acute cellulitis and sepsis.
  18. Content Article
    NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of NHS England and NHS Improvement's campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more.
  19. Content Article
    Alison Phillips tells HSJ her story and why she's campaigning for the deteriorating patient and safety.
  20. Content Article
    This report details the findings of a thematic review of Safe and wellbeing reviews (SWRs) between October 2021 and May 2022. SWRs are undertaken for children, young people and adults that are autistic and/or have a learning disability who are being cared for in a mental health inpatient setting.  SWRs are part of the NHS response to the safeguarding adults review concerning the tragic deaths of Joanna, Jon, and Ben at Cawston Park Hospital, who were each detained for a long period of time and did not receive appropriate care.
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