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Found 11 results
  1. 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
  2. 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
  3. 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
  4. Content Article

    Why I ‘walk on by’

    Anonymous
    Walking by is not what I want to do but walking by is what I do on a regular basis. I am ashamed to write this, to think this, to do this. I don’t think I am alone as I have seen others do it too. We are not bad people, but I can’t help but think that we have turned into bad nurses. The last thing I wanted to be was a bad nurse. This was never the plan… it’s crept in, without me knowing it was happening. Until now. How has this happened? How have I become the nurse I despise? I work on an acute medical admissions unit. We have patients that are admitted from the emergency department (ED). They are unwell, often too unwell to come to us, but patients need to be moved. “Keep ED flowing” – its all about flow. I have begun to hate that word. We have 36 beds in total. We have a nurse/patient ratio of 1:6. Sometimes 1:8 if we are short staffed. Throughout the day we can have up to 12 patients that have passed through those six beds. They go to other medical wards, respiratory wards… anywhere that has space. If we have no room the ED gets backed up and ‘flow’ stops. I have pressure from my nurse in charge to move my patient to another ward, they have pressure from the bed manager, who has pressure from the ops manager. I have sat in on bed meetings, it’s not easy listening. A high up manager barking “we need 45 discharges by mid-day”; it’s not achievable… it goes on every day. I’m getting these patients ready for transfer. Safety booklets, pages long to be completed: nutritional score, waterlow score, bowel chart, touch the toes chart, fluid chart, turns chart, fall proforma, NEWS charting, food chart, clinical pathways, next of kin contact details, let alone my documentation for those few hours they have sat in that bed. All the while, drugs need to be given, intravenous drugs, not just for my patient but I have to help the agency nurse in the next bay as “she can’t do IVs”. Patients need washing, turning, feeding, monitoring, bloods to be taken, wounds to be dressed, hourly pump checks, blood sugar testing, cannulation and conversations with sick patients’ relatives. These are tasks that need to be done on time. If not – trust policy is breached. Some, I just ‘tick’, especially if it’s a checklist. I know I’m not the only one that does this – it’s normal. So, when I’m in the middle of trying to complete these ever-growing tasks, I hear “nurse can you…” “nurse will you just…” “I know you're busy but...” What do I do? I walk on by. I walk at high speed. I have stopped before. It often stops me completing my tasks. I forget what I was meant to be doing. I have missed a crucial blood sugar check for my DKA patient in the past. Patients do not get their medication on time, patients are not transferred on time (it’s all about the flow), safety booklets not completed, handovers rushed and information missed, documentation scant. I’m always in a rush. I know many of the calls are for toileting. This can take a while. I daren’t look at the pressure areas – my heart sinks if there is one… more documentation, more time away from the other tasks. Patients who come in are often at risk of falling, so need two people to help. I know the next-door nurse is just as busy; I feel bad to ask her/him. The healthcare assistant is often too busy to help, getting patients ready for transfer, doing the observations… relentless. Walk on by. Yes, I do. I am not the only one. What are the Trust priorities? Safe care or flow? The Trust will always say safe care. So why set up the environment that causes unsafe care? Mixed messages. I became a nurse to give evidence-based, holistic, safe care. I go home demoralised. I don’t recognise this profession anymore.
  5. Content Article
    Key points: An evaluation of hospital use among 526 residents aged 65 or over living in 15 vanguard nursing or residential care homes in Wakefield between February 2016 and March 2017, compared with a local matched control group. The enhanced support they received had three main strands: voluntary sector engagement, a multidisciplinary team and enhanced primary care support. Estimations show that vanguard residents experienced 27% fewer potentially avoidable admissions than the matched control group – the effect was stronger among those who had been resident in a care home for three months or longer. But there was no conclusive evidence that overall emergency admissions or A&E attendances differed between the vanguard residents and those in the matched control group.
  6. Content Article
    NHS England and NHS Improvement have worked with a number of partners to identify five key principles which can help ensure that patients are discharged in a safe, appropriate and timely way. The five principles relate to different stages of a patient’s stay: some to the moment of admission, some to their time on a ward and some to the end of their stay. Plan for discharge from the start Involve patients and their families in discharge decisions Establish systems and processes for frail people Embed multidisciplinary team reviews Encourage a supported ‘Home First’ approach The 'Where Best Next?' website lists specific actions for each principle and provides links to useful resources.
  7. 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
  8. 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
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