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Found 9 results
  1. Content Article
    Handover in hospitals is the cause of frequent and severe harm to patients, according to new research* by digital health platform, CAREFUL. Many patients are suffering because handover is poorly controlled and under-recognised as a source of clinical risk. Handover is the transfer of responsibility and crucial patient information between practitioners and teams. Handover takes place when shifts change and when patients are transferred between departments or outside of the hospital into another care setting. This is a time when staff are under pressure and when mistakes can happen – as the research shows. “We undertook this research because little is known about how practitioners see the risks of handover and the impact of handover on patient safety,” says CAREFUL CEO, Dr DJ Hamblin-Brown. “We anticipated that doctors and nurses would report some errors, but the frequency with which harm is reported across the world is disturbing.” Patient safety in operating theatres has been a recognised problem for many years – ever since the publication of the original checklist article in the New England Journal of Medicine. By contrast, handover, despite being possibly the most common clinical process across healthcare, has not been studied so widely. CAREFUL’s research investigated clinicians’ experience of handover, receiving 432 completed responses from clinicians in 26 countries via an open, anonymous and confidential online questionnaire. Published in February 2022, the findings revealed that errors in handover occur weekly or daily, according to 12% of respondents. Nearly 10% had witnessed severe harm – either death or otherwise life changing – because of handover error. “Handover takes place about 4,000 times each day in a typical teaching hospital”, explains Dr Hamblin-Brown. “It is a procedure prone to a multitude of errors due to reliance on paper that’s easily lost or verbal discussion that’s easily forgotten.” One of the most worrying findings in the research is that most handover takes place using a many different support systems; 35% are still using handwritten notes; 21% are using office documents such as Word and Excel; 10% write on whiteboards and a full 15% are using unofficial messaging apps like WhatsApp. Healthcare leaders reflect the same concerns as staff, but they specifically also want more access to patient information and better electronic systems. Digital platforms may be the only real solution to the challenges surrounding handover, with the ability to provide safe and secure access to handover information at the swipe of a screen that is neither lost nor forgotten. “We work in an industry that is failing to take seriously the dangers of handover. It is arguably the most common, and one of the most important, processes. We harm both staff and patients if we fail to address the dangers of handover,” concludes Dr Hamblin-Brown. *This paper is in pre-print and has not yet been peer-reviewed.
  2. Content Article
    The report makes the following proposals to the way in which the NHS is organised: We change radically the role of the centre to focus on certain core capabilities that the centre should do and can only do. These would include eventually: a full national public-health data infrastructure, one that is interoperable and capable of bringing all the disparate data sets within the NHS under one roof; electronic personal or health records for all patients with patients given the right to have all their information stored and available to any health-care professional they want anywhere in the NHS system; a revamped NICE, giving guidance on new treatments and drugs; and a process for enabling new learning and sharing of innovation across the service. And of course, the power of intervention in the case of a failing or mismanaged service. Other than for these capabilities, the new integrated care boards, in partnership with clinicians and NHS staff, should have the freedom from central control genuinely to innovate, run the service and manage the budget in the way they see fit to meet the needs of their local patients, which they know best. Going further and faster on devolution is therefore essential. These freedoms should include the ability to enter into partnerships with the private or voluntary sectors, to embrace new methods of treatment and prevention, to create the workforce they believe is best suited to the care they want to provide and to raise money locally through social impact bonds – not as a substitute for taxpayer funding but as a source of better community engagement. In place of a system of accountability based purely on the centre, there should be full transparency and publication of health data, nationally and locally, available to the patient and to the broader public. The NHS should make available – on an anonymised basis – all the data held by the service for the encouragement of research and the development of the British life-sciences sector.
  3. Content Article
    This page links to videos explaining what types of errors and challenges there are when using EHR's. By highlighting these errors and challenges may help mitigate future harm for patients.
  4. Content Article
    We are currently developing the Open Registry infrastructure in South West England, and are bringing together medical device manufacturers (from the world's largest to the smallest) and NHS trusts, with their surgeons that already have relationships with specific manufacturers. Using the system: a patient example Imagine that you are in a consultation with your surgeon, who advises that the mitral valve in your heart needs to be repaired. Your surgeon advises that this procedure can be done with minimally invasive surgery. They recommend using Device-X and you ask, "Why, what evidence do you have that this will work best for me?" Your surgeon replies, "This is the best knowledge that we have." You and your surgeon would then access the Portal. You would search for Device-X, maybe with a specific Unique Device Identification number (UDI) and/or a GMDN code (all of this is presented in a browser to help you search for the correct device). You find from this search that Device-X has been used in patients in three different European countries. You also find that the latest evidence is that it is best suited for patients with large frames, indicating that you may well be better suited to Device-Y. In searching for Device-Y, you also search for the generic description of this device, and find that manufacturers A, D, J and P, all make similar devices of this size, suitable for your needs. Now you search for Adverse Incidents corresponding to Device-Y across all of these manufacturers, and find that there are incidents associated with manufacturers D and P. This enables you and your surgeon to make a better-informed choice about the device that is right for you. How do we acquire medical device data? We have developed a unique capability to acquire data in real-time during surgery, and in association with device manufacturers. Our tech pushes appropriate data into a local registry and this becomes the foundation of data acquisition across Europe. We are already working in Central and Eastern Europe, and are planning a major initiative in Ireland. The Advisory Board comprises: Medical device safety experts Regulatory and Compliance experts Cyber security and data protection experts Patient advocacy experts (unfilled) Notified Bodies (unfilled) The board is chaired by an expert who has been chief executive of two NHS Trusts and worked for NHS England. It is coordinated by a trained anaesthetist and clinical safety expert. The board is also supported by a roundtable of medical device manufacturers, who are committed to making this work happen. They are also committed to total transparency of data. They are funding this work. The support we have been receiving from medical device manufacturers has been astonishing. This is a major opportunity to contribute to patient safety and help transform the patient consent process. If you are interested in finding out more, please contact info@tcc-casemix.co.uk
  5. Content Article
    1. Regulating adaptive AI algorithms Where an AI tool quickly adapts to reflect its environment and the context in which it operates, the AI may “reinforce those harmful biases such as discriminating based on one’s ethnicity and/or gender”. These will further exacerbate existing health inequalities and place certain patients at a disadvantage. It is important that the ground rules for these AI tools include firm parameters that seek to prioritise patient safety. A bit like Asimov’s Zeroth Law, ”a robot may not harm humanity, or, by inaction, allow humanity to come to harm”. 2. Hacking medical devices remotely The idea that hackers might target people's implantable cardiac devices was popularised in a 2012 episode of the US television drama ‘Homeland’, in which terrorists hacked a fictional vice president's pacemaker and killed him. It is not just VIPs (or VPs) who need to worry about this. Potentially anyone with an implanted device could have it hacked and be held to ransom. Medical device manufacturers should take far more care in the security that they build into their devices to protect patients from unwarranted attacks on them. Frankly, when large healthcare organisations are procuring these types of devices, this is one of the key areas that they should be interrogating their potential suppliers about. 3. Privacy breaches by and on direct-to-consumer devices and services This is a difficult one because if we want digital systems to really understand us and provide advice or treatment personalised to us, then those digital tools must have access to our confidential medical data. However, privacy is still very much a high priority for most patients and they (rightly) want to know what is happening to their data – who is using it, how long is it being held, is it being passed on to third parties without the patient’s explicit consent? People often forget who they have given access to their data, for what purpose and sometimes stop using a digital tool without realising that all of their data is still being held (and possibly collected via an active API) by the digital tool’s supplier. It would be helpful if our mobile phones and PCs could highlight: a. When we shared sensitive data, who with, and what data was shared. b. A list of active APIs that are still sharing our data, etc. Data that is used for purposes other than those intended by the patient are potentially a safety risk to that patient and should be treated as such. 4. Ransomware attacks on hospitals Yes, this is awful for the hospital, and yes, it may cost them money; however, let’s not forget whose data has been stolen, the patients’! Are they sufficiently alerted to this, told what is happening, given ways to mitigate any issues to them personally? In an ideal world they are, but in reality the hospital is probably in panic mode and communicating transparently with patients is low down on its priority list. As the Medical Futurist says: “The average patient should demand more security over their data” – but how do they do this? What can a single patient do to ensure that the hospitals who have stewardship over their data (not ownership in my opinion) make it as secure as possible. This brings me back to an idea that my sadly departed friend, Michael Seres, had many years ago. On each hospital exec team (not Board) there should be a Chief Patient Officer, whose job it is to push for patient interests in operational matters (which is why they shouldn’t be a non-exec member of the Board). That is the person whose job it should be to hold their organisation to account over the security of their patients’ data. 5. Technologies supporting self-diagnosis Dr Google has been an issue for some years, and people’s off-the-shelf devices that monitor their vital signs are not necessarily medical grade, nor do their users generally have the skill to interpret the outputs from them. However, doctors should embrace patients who are keen to manage their own chronic conditions and support them in doing so. This ‘shared accountability’ has to be the model for improved population health and doctors not willing to work with their patients shouldn’t have any. 6. Bioterrorism through digital health technologies A bit exotic this one and certainly not a near-term risk when looking at the sorts of things described in the newsletter. However, in a world that is still dealing with a pandemic, and reliant on vaccines to gain some normality back into our everyday lives, the security of (for example) that supply chain is critical. What if a batch was intentionally sabotaged or in some way its efficacy reduced? In exactly the same way that medical products (especially implants) should be made as safe and secure as possible, the same is true for the medicines that we rely on. 7. AI not tested in a real-life clinical setting The newsletter makes the case for issues related to how staff use the AI, but PLEASE… test this with patients first! Safety in use is critical and only feedback involving patients will help developers to optimise these digital tools to be as safe as possible. 8. Electronic medical records not being able to accommodate patient-obtained digital health data This is a very personal issue for me. Why should my doctor have to send me for tests when I can give him/her perfectly reasonable data that I have gathered myself from a device that has been CE marked and approved by the FDA/MHRA etc.? Electronic Medical Record vendors are incredibly reticent to allow anyone other than the authorised doctor to enter anything into a patient’s record. There are some good reasons for this. However, I’ve long thought that there could be an annexe to the record that is patient-controlled where they can enter a new address, add data from their own blood pressure device and over-the-counter drugs or remedies that they are taking. That way, doctors would have an up to date, (hopefully) reliable set of data to have a more informed discussion with their patient and it could accelerate the time between consultation and referral/treatment. 9. Face recognition cameras in hospitals I’m less worried by this in principle; however, I am interested to know how the data generated will be used and the security around it. If it is only used by the hospital to optimise patient flow, or remotely detect symptoms that are then used to help patients either directly or indirectly, then fine. If it is shared with others for more sinister purposes, then I would be concerned. 10. Health insurance: Dr Big Brother This is less relevant to the UK – only 11% of us have private health insurance. Again, this boils down to who collects data on patients, for what purposes, is explicit consent gained from the patient to share their data and how may those third parties use it? There are both negative and positive connotations to the gathering of a person’s health data by their health insurance company, but given that they already ask for access to all GP and secondary care records, having access to health wearable data (as Vitality Health already does) is not a big step. Conclusion I still believe that the benefits of digital health outweigh the risks, but the risks outlined above are not inconsequential. Many of the negative aspects are predicated on poor management and control of patient data. One of the ways that this should be mitigated is to have one or more patient representatives at an exec (not non-exec) level who hold healthcare organisations to account over this important aspect of care provision.
  6. Content Article
    During the initial impact of the COVID-19 pandemic, the Government recognised that a key enabler would be to increase capacity within the NHS, ensuring that enough acute beds were available to cope with the rising tide of patients. An important policy priority has been to ensure the safe discharge of patients back into their home or, where appropriate, into a placement with a community provider. While there were already pathways in place to accelerate this process, responding to the pandemic required a significant acceleration of hospital discharges. Hospital discharges are complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to equip the home or community setting with the appropriate equipment and care plans. In this submission to the Inquiry, Patient Safety Learning and CECOPS focus on: Rapid hospital discharge - considering the challenges to this caused by the pandemic, the importance of interoperability in overcoming these, preventing care homes and nursing homes becoming vectors of transmission and harnessing digital technologies, such as an app, to assist hospital discharges. Community support - as the rate of hospital discharges significantly increases, the need to consider the availability of Personal Protective Equipment supplies, access to and guidance on supportive equipment and technologies and other pressures that will need to be met by community support services. In the concluding comments the submission sets out an eight-point action plan required to tackle this issue: A model of demand to inform hospital discharge and planning of community and care services New agile ways of working using digital technologies. An improved cross health and social care information system is imperative to ensure safe transfers of care Strengthened cross-sector leadership and communication with clinical teams and patients and families The provision of equipment services addressed urgently - to support hospital discharge and prevent admissions i.e. wheelchair, prosthetic, orthotic and equipment services Integration of planning and service delivery across sectors with the right leadership, the ability and capacity at a local level to streamline services and procurement to the needs of patients, families, and care providers Innovation in the development of safe transfers of care. We must adapt the traditional bureaucratic processes and regulatory framework to ensure that the needs of patients are met speedily Financial support to ensure that there is capacity to provide community-based care The safety of patients at the core of all plans and service delivery. All plans should include how the safety of patients is being prioritised. References [1] UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 7 May 2020. https://committees.parliament.uk/work/277/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/ [2] UK Parliament, Call for evidence: Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 29 April 2020. https://committees.parliament.uk/call-for-evidence/131/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/
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