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Content ArticleA tracheostomy is a common procedure done for patients who need prolonged mechanical ventilation, are unable to protect their airway or have pathologies of the oropharynx leading to the potential for upper airway obstruction. While a tracheostomy is relatively safe, complications are common, and it is essential to understand the management steps to ensure that the patient’s tracheostomy functions as intended. In a single centre study of 100 patients undergoing tracheostomy, the complication rate was 47% during the initial hospitalisation. The most common complications included obstruction of the tracheostomy (19%), bleeding (16%), infection (14%), and accidental decannulation (13%). While these complications are common, if managed appropriately, mortality directly related to the tracheostomy has a very low incidence. This article in the Anaesthesia Patient Safety Foundation newsletter discusses how to keep patients safe during emergency tracheostomy management.
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Content ArticleMost hospitals have stopped testing all patients for Covid-19 when they are admitted and no longer require masking. Ten hospitals in the Mass General Brigham hospital system ended both these precautions simultaneously in May 2023 but restarted masking for health care workers in January 2024 during a winter respiratory viral surge. This study in JAMA Network Open looked at the association of these changes with the relative incidence of hospital-onset Covid-19, influenza and respiratory syncytial virus (RSV). The study showed that stopping universal masking and Covid-19 testing was associated with a significant increase in hospital-onset respiratory viral infections relative to community infections. Restarting the masking of health care workers was associated with a significant decrease.
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News Article
Breathing issues cause more emergency NHS admissions than any other condition
Patient Safety Learning posted a news article in News
Serious breathing problems lead to more emergency admissions to hospital in England than any other medical condition, NHS data reveals. More people with asthma, bronchitis or emphysema have to go into hospital for treatment because they are struggling to breathe than those with heart disease, joint problems or cancer. During 2023-24 hospitals in England recorded 868,212 emergency admissions for diseases of the respiratory system, NHS figures obtained by Asthma + Lung UK show. That represented one in eight of all the 5.2m unplanned admissions during the year. Such admissions are contributing significantly to hospitals being overwhelmed so often, and especially during winter, when cold weather breeds infections, the charity said. Asthma + Lung UK claims the number of unplanned stays in hospital for breathing problems is so high because of a “collapse in care for people with lung conditions” in recent years. “Lung conditions are silently suffocating the NHS, pushing it to breaking point and causing 66,524 deaths every year,” said Sarah Sleet, its chief executive. “Every day, people with respiratory conditions are needlessly suffering, hospitals are overwhelmed by emergency admissions for breathing issues, particularly during the winter.” Read full story Source: The Guardian, 11 November 2024 -
News Article
200 patients failed after hospital missed warning
Patient Safety Learning posted a news article in News
Hundreds of patients got the wrong or no treatment for a lung condition, a trust investigation has found, five years after concerns were first raised. Epsom and St Helier University Hospitals Trust has published a report accepting that 216 of its interstitial lung disease patients had either not had their condition investigated properly, were given no treatment or the wrong treatment, or were not properly referred onwards. The trust, part of a hospital group with St George’s in south west London, said the failures were down to a single consultant who left the trust last year. The report said a Datix incident report about the issue had been submitted in November 2019 but nothing was done until further concerns were raised in 2023 in Datix reports, Freedom to Speak Up reports and alerts to Health Education England by trainee doctors. The trust would not clarify whether concerns were raised at any point between November 2019 and 2023, saying it was something an external investigation would look at. Read full story Source: HSJ, 11 November 2024 -
Content ArticleThis report summarises the findings of an evaluation conducted by Health Innovation East and Health Innovation Manchester on behalf of the national Innovation Collaborative for digital health. It presents findings from an evaluation of a chronic obstructive pulmonary disease (COPD) virtual ward that falls within a virtual hospital managed by South and West Hertfordshire Health and Care Partnership. It aims to inform the potential wider adoption of the virtual ward model across the UK and understand the model’s potential to support people with other health conditions. It also considers the success of South and West Hertfordshire Health and Care Partnership Virtual Ward objectives to improve patient care, clinical outcomes, healthcare utilisation, and patient and staff satisfaction.
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Content ArticleIn anticipation of an increase in patients requiring a temporary tracheostomy due to the huge surge in patients placed on ICU ventilation at the peak of the COVID-19 pandemic, the NHS England National Patient Safety Team launched a National Patient Safety Improvement programme to rapidly support the NHS to provide safe tracheostomy care. Tracheostomy is a procedure to provide an artificial airway to assist breathing. A small surgical opening is made through the front of the neck into the windpipe and a curved plastic tube, known as a tracheostomy tube, is placed through the hole allowing air to flow in and out of the windpipe. There are various reasons why someone might need a tracheostomy. The commonest reasons are due to a blockage of the normal air passages (nose and mouth or at the back of the throat) or because a patient needs help from a ventilator for more than a few weeks. Previous research showed up to 30% (nearly one in three) patients receiving tracheostomy care have been found to suffer from avoidable harms related to lack of equipment, staff training, and/or limited infrastructure. During the pandemic this risk increased as patients with temporary tracheostomies were managed in makeshift ICUs or ward areas, and by staff who may not be familiar with the key principles to keep these complex and vulnerable patients safe. To support staff to keep tracheostomy patients safe at this challenging time, the National Patient Safety Improvement Programme expanded the work of the Improving Tracheostomy Care (ITC) project, that had been working with 20 NHS sites between 2016 and 2019; and commissioned the Academic Health Science Network’s (AHSN) 15 Patient Safety Collaboratives to rapidly deliver safety interventions across 180 NHS hospital sites in England. Central to this was the roll out of the three safety specific strategies (interventions) from the ITC programme: Standardised tracheostomy care bundles – evidence-based practices that are grouped together to encourage the consistent delivery of safe care. Bedhead signs – providing specific key information about the patient’s tracheostomy, along with details of what staff should do in an emergency and who to call for help. Standardised bedside and ward tracheostomy equipment – ensuring emergency equipment needed to manage a blocked or displaced tube was immediately available at all times, and accompanied the patient wherever they went during their hospital stay A ‘Safer Tracheostomy Care – a toolkit for healthcare staff’ was also developed by a multi-disciplinary team to further support healthcare staff.
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Content Article
This report from Asthma + Lung UK highlights that lung diseases such as COPD, asthma and pneumonia are the third leading cause of death in England, whilst the UK as a whole has the worst death rate from lung disease in Europe. Hospital admissions for lung diseases have doubled in the last 20 years and lack of proper testing for lung diseases is having an impact on patient safety, as GPs have to "guess" diagnoses. The report highlights three areas where policy changes should be implemented in order to improve care for people affected, reduce pressure on services and deliver massive savings for the NHS: Diagnosing lung disease early and accurately Keeping people healthy and out of hospital Providing treatments that work -
News ArticleBabies could be needlessly hospitalised this winter because the government has delayed a vaccine that protects them from a life-threatening virus, the UK’s top children’s doctor has warned. Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health (RCPCH), said she was “frustrated” by delays in introducing a new vaccine for respiratory syncytial virus (RSV), which drives 30,000 hospital admissions each winter and leads to dozens of deaths. She warned the delay meant thousands of children’s operations will have to be cancelled as RSV patients fill up beds – piling further pressure on already soaring waiting lists. It comes after the UK’s most senior A&E doctor, Dr Adrian Boyle, told The Independent that the government’s failure to prepare the NHS for winter could see thousands of people die needlessly this year. The Joint Committee on Vaccination and Immunisation (JCVI) said in June that a rollout of two RSV vaccines, one for babies and one for pregnant women, would be “cost-effective”, while the UK Health Security Agency (UKHSA) said there was a “strong case” for a jab. But it confirmed there was no timeframe for when vaccinations could start. Read full story Source: The Independent, 4 September 2023
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News Article
US approves first RSV vaccine for use during pregnancy to protect babies
Patient Safety Learning posted a news article in News
US regulators this week have approved the first RSV vaccine for pregnant women so their babies will be born with protection against the respiratory infection. The Food and Drug Administration cleared Pfizer’s maternal vaccination to guard against a severe case of RSV when babies are most vulnerable – from birth through six months of age. The next step: the Centers for Disease Control and Prevention must issue recommendations for using the vaccine, named Abrysvo, during pregnancy. “Maternal vaccination is an incredible way to protect the infants,” said Dr Elizabeth Schlaudecker of Cincinnati Children’s Hospital, a researcher in Pfizer’s international study of the vaccine. If shots begin soon, “I do think we could see an impact for this RSV season.” RSV is a coldlike nuisance for most healthy people but it can be life-threatening for the very young. It inflames babies’ tiny airways so it’s hard to breathe or causes pneumonia. In the US alone, between 58,000 and 80,000 children younger than five are hospitalised each year, and several hundred die, from the respiratory syncytial virus. Read full story Source: The Guardian, 22 August 2023 -
News Article
GPs given freedom to order heart checks direct
Patient Safety Learning posted a news article in News
GP practices in England will be able to order a host of checks directly to help speed up the diagnosis of a range of heart and respiratory conditions. Traditionally GPs refer to specialists when conditions like heart failure and lung problems are suspected. But the ability to direct refer, which was rolled out for cancer last year, is now being extended. GPs welcomed the move, but questioned whether there was sufficient testing capacity to cope. Royal College of GPs chair Prof Kamila Hawthorne said: "Any initiative to accelerate the process by which patients can be diagnosed and begin to receive any necessary treatment should be seen as positive." She said GPs had "long been calling" for better access to diagnostic tests. But she added: "For this initiative to be successful, it is vital that diagnostic capacity - both in terms of testing and people to conduct and interpret tests - is sufficient." Read full story Source: BBC News, 3 August 2023 -
News ArticleMinisters are being urged to roll out a better testing regime for one of the country’s biggest killers, with the most recent figures showing death rates for chronic obstructive pulmonary disease more than three times higher in some of the most deprived areas of the country. More than 20,000 people a year in England die from chronic obstructive pulmonary disease. The most significant cause of COPD is smoking, but a significant proportion of cases are work-related, triggered by exposure to fumes, chemicals and dust at work. Figures from the Office for National Statistics reveal that death rates from the disease are significantly higher in more deprived areas of the country. The NHS is rolling out targeted lung screening across England for people aged between 55 and 74 who are current or former smokers. The charity Asthma + Lung UK says the checks will identify many people who may have COPD, but there is no established protocol for them to be diagnosed and given appropriate treatment and support. Dr Samantha Walker, interim chief executive at Asthma + Lung UK, said: “Once targeted lung health checks are fully rolled out, millions of people could be told they have an incurable lung disease like chronic obstructive pulmonary disease, but they won’t be given a firm diagnosis or signposted to the right support, which is simply unacceptable. “What we need to see is a national referral pathway in place for those people who show signs of having other lung conditions as part of this screening process to ensure that people with all suspected lung conditions get the diagnosis and treatments that they deserve. We know that people with lung disease will live better, fuller lives with an earlier diagnosis.” Read full story Source: The Guardian, 24 March 2024
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EventuntilJoin respiratory specialists, Dr Daryl Freeman and Dr Vincent Mak, for this interactive webinar. This 1-hour, interactive webinar will cover: Community ‘hublets’. The outpatient transformation workstream. Community Diagnostic Centres (CDCs) and Primary Care Networks (PCNs). Quality assurance and interpretation of spirometry. Register
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EventDr Donna Prosser, Chief Clinical Officer at the Patient Safety Movement Foundation, is joined by a group of experts, including pharmacists, anesthesiologists, respiratory therapists, family members, and nursing leaders, to explore the patient safety priorities of sedation, opioid therapy and respiratory depression. The group will discuss frequently encountered safety issues, explore organisational processes to reduce sedation safety events, and assess the role patients and family members can play in reducing harm. Register
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News Article
COVID-19: Lung damage 'identified' in study
Patient Safety Learning posted a news article in News
COVID-19 could be causing lung abnormalities still detectable more than three months after patients are infected, researchers suggest. A study of 10 patients at Oxford University used a novel scanning technique to identify damage not picked up by conventional scans. It uses a gas called xenon during MRI scans to create images of lung damage. Lung experts said a test that could spot long-term damage would make a huge difference to Covid patients. The xenon technique sees patients inhale the gas during a magnetic resonance imaging (MRI) scan. Prof Fergus Gleeson, who is leading the work, tried out his scanning technique on 10 patients aged between 19 and 69. Eight of them had persistent shortness of breath and tiredness three months after being ill with coronavirus, even though none of them had been admitted to intensive care or required ventilation, and conventional scans had found no problems in their lungs. The scans showed signs of lung damage - by highlighting areas where air is not flowing easily into the blood - in the eight who reported breathlessness. The results have prompted Prof Gleeson to plan a trial of up to 100 people to see if the same is true of people who had not been admitted to hospital and had not suffered from such serious symptoms. He is planning to work with GPs to scan people who have tested positive for COVID-19 across a range of age groups. The aim is to discover whether lung damage occurs and if so whether it is permanent, or resolves over time. Read full story Source: BBC News, 1 December 2020 -
News ArticleThe lungs and hearts of patients damaged by the coronavirus improve over time, a study has shown. Researchers in Austria recruited coronavirus patients who had been admitted to hospital. The patients were scheduled to return for evaluation 6, 12 and 24 weeks after being discharged, in what is said to be the first prospective follow-up of people infected with COVID-19, which will be presented at today's European Respiratory Society International Congress. Clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, and lung function tests were carried out during these visits. At the time of their first visit, more than half of the patients had at least one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. But by the time of their next visit, 12 weeks after discharge, the symptoms had improved, and lung damage was reduced to 56%. Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study, said: "The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves." A separate presentation to the congress said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery. Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University in France, used a walking test to evaluate the weekly progress of 19 patients who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for pulmonary rehabilitation. She said: "The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients' walking and breathing capacities and muscle gain." Read full story Source: The Independent, 7 September 2020
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News Article
Non-invasive ventilation deaths fell for first time in 2019, audit finds
Patient Safety Learning posted a news article in News
Inpatient mortality among people receiving non-invasive ventilation (NIV) has decreased for the first time since 2010, falling from 34% in 2013 to 26% in 2019, figures released by the British Thoracic Society show. The annual National Adult Non-Invasive Ventilation audit, which began in 2010, reported “substantial improvements in processes of care and patient outcomes” in 2019 when compared with previous years. “Some improvement in overall mortality may be attributed to improved patient selection,” it said. “Mortality outcomes were lower for each diagnostic category, and most notably for patients with COPD [chronic obstructive pulmonary disease] and obesity-related respiratory failure.” Read full story (paywalled) Source: BMJ, 10 July 2020 -
News Article
Winter warning as 35,000 respiratory diagnoses delayed due to pandemic
Patient Safety Learning posted a news article in News
Patients with respiratory disease have been overlooked during the COVID-19 pandemic, with the NHS storing up problems for the winter months, a group of experts including the Royal College of General Practitioners (RCGP) has warned. Analysis by the 34-member Taskforce for Lung Health showed that referrals for lung conditions fell by 70% in April, with two-in-five (39%) of CCGs seeing no appointment bookings for respiratory conditions for the whole of May. On average, the group calculated a weekly average of 3,399 lung patients missing out on urgent and routine referrals during the COVID-19 lockdown, amounting to a total of at least 34,780 people, based on NHS England data. This was blamed in part on a general reduction in routine procedures during the pandemic, which will have affected all disease areas, but also the limitations on clinicians including GPs to carry out spirometry due to the risk of COVID-19 infection spread. But the taskforce - which includes the RCGP and the Primary Care Respiratory Society, as well as the Royal College of Physicians and Asthma UK - is now calling on NHS England to urgently restore services to pre-pandemic levels to tackle the backlog of lung patients requiring support. It said that failure to do so risked causing the premature death of patients who require urgent diagnosis as well as overwhelming the NHS during the winter season, when respiratory symptoms worsen. Read full story Source: Pulse, 9 July 2020 -
News Article
Coronavirus: Warning thousands could be left with lung damage
Patient Safety Learning posted a news article in News
Tens of thousands of people will need to be recalled to hospital after a serious OVID-19 infection to check if they have been left with permanent lung damage, doctors have told the BBC. Experts are concerned a significant proportion could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue. Research into the prevalence of lung damage caused by COVID-19 is still at a very early stage. It's thought those with a mild form of the disease are unlikely to suffer permanent damage. But those in hospital, and particularly those in intensive care or with a severe infection, are more vulnerable to complications. In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital. Radiologists in the UK say, based on the early results of follow-up scans, they are concerned about the long term-effects of a serious infection. Prof Gisli Jenkins, of the National Institute for Health Research, is running assessment clinics for those discharged from hospital with COVID-19. He said: "My real concern is that never before in our lifetime have so many people been subject to the same lung injury at the same time." NHS England has said it is planning to open a number of specialist COVID-19 rehabilitation centres to help patients recover from long-term effects, including possible lung damage. Read full story Source: BBC News, 24 June 2020 -
News ArticleDemand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned. NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases. Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”. “We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.” The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19. Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”. Read full story Source: The Independent, 16 June 2020
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Content ArticlePatients with respiratory disease deserve a correct diagnosis and guideline driven care that is standardised, patient focussed and delivered by a healthcare professional with suitable training and experience in a site and timeframe to meet their needs. Sadly, patient groups such as the BLF and Asthma UK have recognised that this is often not the case. The Respiratory Service Framework (RSF) attempts to demonstrate what that excellence is – and how it may be delivered at a population level. Developed by the Primary Care Respiratory Society (PCRS) Service Development Committee, the Respiratory Service Framework helps those looking to design a patient focussed respiratory service working across all sectors of out of hospital care to see the ideal components for a given population of patients. It has been designed to be applicable and helpful to those delivery care at a PCN or ICS level.
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Content ArticleWhile improving over time, the outcomes for lung cancer patients were already dramatically below those with other cancers before the pandemic. This report from the World Economic Forum, is designed to help governments, health systems, healthcare professionals and others to come together to: understand the effect of the pandemic on lung cancer care address the immediate impact of the pandemic on lung cancer services ensure their resilience in the longer term so that we can go further than ever before to improve patients’ outcomes.
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Content Article
Guidance for: Prone positioning in adult critical care (2019)
Sam posted an article in Respiratory conditions
Guidance from the Faculty of Intensive Care Medicine and Intensive Care Society on prone positioning in adult critical care. It is hoped that the adoption of the guidance set out within this document will help improve safety and reduce complications associated with the prone positioning of mechanically ventilated patients. This document also hopes to standardise the approach to manging a cardiac arrest in the prone position, and has some guidance on prone ventilation in ECMO patients as well as considerations for performing bronchoscopy in the prone position. Assuming adequate staffing and equipment is available, the intervention of prone positioning involves very low costs and provided additional patient complications and long-term injuries to staff do not occur, would almost certainly be a cost-effective intervention. -
Content ArticlePatients with respiratory disease deserve a correct diagnosis and guideline driven care that is standardised, patient focussed and delivered by a healthcare professional with suitable training and experience in a site and timeframe to meet their needs. Sadly, patient groups such as the BLF and Asthma UK have recognised that this is often not the case. The Respiratory Service Framework (RSF) attempts to demonstrate what that excellence is – and how it may be delivered at a population level. Developed by the PCRS Service Development Committee, the Respiratory Service Framework helps those looking to design a patient focussed respiratory service working across all sectors of out of hospital care to see the ideal components for a given population of patients. It has been designed to be applicable and helpful to those delivery care at a PCN or ICS level.
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Content Article
Capnography: No Trace = Wrong Place
Patient Safety Learning posted an article in Patient management
The Royal College of Anaesthetists (RCoA) and the Difficult Airway Society (DAS) have collaborated to create the video resource Capnography: No Trace = Wrong Place. Presented by Professor Tim Cook, the video shares the important message that during cardiac arrest, if a capnography trace is completely flat, oesophogeal intubation should be assumed until proven otherwise. -
Content ArticleThis article describes the application of colour coding for cognitive aids to facilitate the management of an unanticipated difficult airway and its further local implementation in the form of a colour-coded difficult airway trolley. The authors conclude that the use of colour coding as a cognitive aid can enhance the management of an unanticipated difficult airway and make it simpler to obtain help from other operating room personnel who are not regularly involved in airway management. However, they note that frequent training and simulation with the material and equipment in the difficult airway trolley remains crucial.
