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Showing results for tags 'Operating theatre / recovery'.
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News ArticleLondon’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
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Four trusts cancel planned operations as covid pressures mount
Patient Safety Learning posted a news article in News
All non-urgent elective operations are being postponed for at least two weeks in a health system still seeing significant and growing pressure from coronavirus. The four acute trusts in Kent and Medway will still carry out cancer and urgent electives, but other work is being postponed. Relatively few elective operations are usually carried out around Christmas and New Year, meaning the county is likely to see little or no elective work for the next four weeks. In a covid update bulletin issued last night, the Kent and Medway Clinical Commissioning Group acknowledged the pressure hospitals across its area were under but stressed cancer and other urgent operations would go ahead. It added: “However, we are now pausing non-urgent elective services. This will allow staff to move to support the increased number of covid-19 patients. “Initially this will be for a two-week period. We will keep this under weekly review and will contact individual patients where appointments need to be rescheduled.” Read full story (paywalled) Source: HSJ, 8 December 2020 -
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Surgical skills videos: Medicine Gov Youtube Channel
Steve Turner posted an article in Surgery
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News ArticleMore than a million patient operations could be delayed because of widespread shortages of anaesthetists in the NHS – with 9 out of every 10 hospitals reporting at least one vacancy. As coronavirus paralysed the NHS earlier this year, more than 140,000 NHS patients have already waited over a year for treatment. The Health Foundation has warned that 4.7 million fewer patients have been referred for treatment because of the impact of coronavirus on NHS services. The Royal College of Anaesthetists (RCOA) told The Independent the scale of the vacancies was getting worse and labelled it a “workforce disaster” that could cost patients’ lives and have a widespread impact on hospital services. Read full story Source: The Independent, 22 November 2020
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News ArticleDeath rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found. A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019. Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%. But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6% The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013. Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review. Read full story (paywalled) Source: HSJ, 20 November 2020 .
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Patient Safety Authority: Surgical fires
Patient Safety Learning posted an article in Surgery
In 2012, the Pennsylvania Patient Safety Authority published an analysis of surgical fires reported through its database for the primary purpose of determining whether surgical fires continued to be a problem. In 2018, the Authority published an update, including analysis of events reported from 1 July 2011 through to 30 June 2016. The model suggests a 71% decrease in the patient risk of surgical fires from 2005 to 2016. The analysts noted that in 2005, there was about one surgical fire per month in Pennsylvania, and, if the downward trend continues, the rate will be only one surgical fire per year in 2032. -
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Labour demands new NHS investment as patients wait longer for surgery
Patient Safety Learning posted a news article in News
Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations. The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones. Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016. An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year. There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks. The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks. There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients. Read full story Source: 17 November 2020 -
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Hospital cancels operations as Covid patient numbers soar
Patient Safety Learning posted a news article in News
A hospital in Yorkshire has said it is cancelling planned surgeries for at least two weeks as the number of coronavirus patients there hits levels not seen since May. Bradford Teaching Hospitals said it was being forced to stop non-urgent surgery and outpatient appointments for two weeks from Tuesday because of the numbers of severely ill COVID-19 patients. In statement the hospital said it had seen a spike in admissions in the last few days with 100 coronavirus patients now on the wards with 30 patients needing oxygen support – the highest number of any hospital in the northeast and Yorkshire region. It also said more patients were needing ventilators to help them breathe in intensive care. The trust is the latest to announce cancellations, joining the University Hospitals of Birmingham, Nottingham University Hospitals and Plymouth Hospitals as well as those in Liverpool and Manchester where hundreds of Covid patients are being looked after. Read full story Source: The Independent, 21 October 2020 -
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Content ArticleBased on an analysis of surgical data received through the Patient Safety Organization, plus detailed research and expert evaluation, this Deep Dive identifies and provides actionable recommendations and tools on six key risk categories of adverse event reports related to operative procedures: complications patient and OR readiness retained surgical instruments contamination equipment failures wrong surgery. There are common themes echoed through each of the six event types examined in this Deep Dive. These include the following: Communication problems are an underlying issue. Problems with communication—whether between the scheduler and the OR team, between clinical staff and the patient, or among the OR team—can lead to adverse events or near misses. Organisations should promote a team approach. Taking a team approach to surgical procedures can help avoid many of the adverse events reported in this Deep Dive. Such an approach is an element of a culture of safety and should be emphasised through team-building exercises. Organisations should focus on addressing preventable events. Some events are not preventable, meaning that no matter how well the team prepares, the event would likely have happened anyway. For example, the patient could have an allergic reaction resulting from an unknown anesthesia allergy, or a rare but known risk of surgery occurring. Focusing on preventable events can help focus the surgical team’s attention, however, thereby reducing the risk of unpreventable events as well. Quality improvement should be emphasized to reduce risk. Clinical staff should apply a quality improvement mentality to any problems that emerge, and focus on actions that can be taken to prevent such problems in the future.
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Content ArticleThis report teases out the ‘ingredients’ for successful team working at system, organisational, team and individual level. In the COVID-era, multidisciplinary perioperative teams can be at the front and centre of supporting staff to deliver the best possible care. Key messages Our review found that multidisciplinary working is worth prioritising. There is evidence that in some cases multidisciplinary working can: speed access to surgery, if that is an appropriate treatment option improve people’s clinical outcomes, such as reducing complications after surgery reduce the cost of surgical care by helping people leave hospital earlier However, these benefits are not always apparent. More work is needed to explore which types of multidisciplinary working are most effective and what infrastructure and resources are needed to strengthen and sustain multidisciplinary care around the time of surgery.
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News ArticleThe surgeon at the centre of a body parts scandal operated on patients who were dangerously sedated so that their procedures could be carried out simultaneously, according to a leaked investigation seen by The Independent. Renowned hip surgeon Derek McMinn and two anaesthetists at Edgbaston Hospital, Birmingham, were accused of putting “income before patient safety” in the internal investigation for BMI Healthcare, which runs the hospital. It comes after a separate review found that McMinn had hoarded more than 5,000 bone samples from his patients without a licence or proper permission to do so over a period of 25 years, breaching legal and ethical guidelines. Police are investigating a possible breach of the Human Tissue Act. According to the report on sedation by an expert from another hospital, the two anaesthetists, Imran Ahmed and Gauhar Sharih, sedated patients for so long that their blood pressure fell to dangerous levels in order to allow McMinn to carry out near-simultaneous surgery. It found this meant long delays in the operations starting, with one sedated patient being subjected to prolonged anaesthesia for longer than one hour and 40 minutes – recommended best practice is 30 minutes. Another patient was apparently "abandoned" for an hour and 26 minutes after their surgery was only partially completed while McMinn began operating on another patient. The report’s author, expert anaesthetist Dr Dhushyanthan Kumar of Coventry’s University Hospital, said this was unsafe practice by all three doctors and urged BMI Healthcare to carry out a review of patients to see if any had suffered lasting brain damage. Both anaesthetists work for the NHS – Ahmed at Dudley Group of Hospitals, Sharih at University Hospitals Birmingham – without restrictions on their ability to practise. Read full story Source: The Independent, 30 September 2020
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News ArticleFor more than two decades, Derek McMinn harvested the bones of his patients, according to a leaked report – but it was not until last year that anyone challenged the renowned surgeon. The full scale of his alleged collection was apparently kept from the care regulator until just days ago, and thousands of those who went under his knife for hip and knee treatment still have no idea that their joints may have been collected in a pot in the operating theatre, and stored in the 67-year-old’s office or home. Clinicians and managers at the BMI Edgbaston Hospital, where McMinn carried out the majority of his operations, actively took part in the collection of bones and – even after alarms were raised – the hospital did not immediately act to stop the tissue being taken away, according to a leaked internal report seen by The Independent. An investigation found operating theatre staff at the private hospital left dozens of pots containing joints removed from patients femurs during hip surgery in a storage area, in some cases for months. According to the report, there had been warnings about their responsibilities under the Human Tissue Act when an earlier audit between 2010 and 2015 identified the storage of femoral heads, the joints removed in the procedure. The internal report said there was no evidence McMinn had carried out any research or had been approved for any research work – required by the Human Tissue Authority to legally store samples. It said one member of staff told investigators the samples were being collected for research on McMinn’s retirement. Although the Care Quality Commission knew about claims that a small number of bones being kept by McMinn, it is understood that the regulator received a copy of the BMI Healthcare investigation report only last Friday, after The Independent had made initial inquiries about the case. That report suggests a minimum of 5,224 samples had been taken by McMinn. The regulator confirmed to The Independent it had not been aware of the extent of McMinn’s supposed actions. An insider at BMI Healthcare accused the company of “covering up”, adding: “Quite senior staff at the hospital went along with it and just handed the pots over to his staff when they came to collect them.” Read full story Source: The Independent, 30 September 2020
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Further serious patient safety incidents: why are staff still not being listened to when concerns are raised?
Anonymous posted an article in Whistle blowing
Complaints from staff are not being heeded. Why is it that healthcare staff's opinions and pleas for their safety and the safety of patients do not matter? Here are just some examples of where safety has been compromised: Disposable gowns are being reused by keeping them in a room and then reusing after 3 days. There were no fit tests. Staff were informed by management that "one size fits all, no testers or kits available and no other trusts are doing it anyway". Only when the Health and Safety Executive (HSE) announced recently that fit tests were a legal requirement, then fit tests were given. I queried about fit checks only to discover that it was not part of the training and, therefore, staff were wearing masks without seals for three months before fit tests were introduced and even after fit tests! I taught my colleagues how to do fit checks via telephone. There was no processes in place at the hospital to aid staff navigation through the pandemic (no red or green areas, no donning or doffing stations, no system for ordering PPE if it ran out); it was very much carry on as normal. A hospital pathway was made one week ago, unsigned and not referenced by governance, and with no instructions on how to don and doff. Guidelines from the Association for Perioperative Practice (AFPP) and Public Health England (PHE) for induction and extubation are not being followed – only 5 minutes instead of 20 minutes. Guidelines state 5 minutes is only for laminar flow theatres. None of the theatres in this hospital have laminar flow. One of my colleagues said she was not happy to cover an ENT list because she is BAME and at moderate/high risk with underlying conditions. She had not been risk assessed and she felt that someone with lower or no risk could do the list. She was removed from the ENT list, told she would be reprimanded on return to work and asked to write a report on her unwillingness to help in treating patients. The list had delays and she was told if she had done the list it would not have suffered from delays. Just goes to show, management only care about the work and not the staff. It was only after the list, she was then risk assessed. Diathermy smoke evacuation is not being used as recommended. Diathermy is a surgical technique which uses heat from an electric current to cut tissue or seal bleeding vessels. Diathermy emissions can contain numerous toxic gases, particles and vapours and are usually invisible to the naked eye. Inhalation can adversely affect surgeons’ and theatre staff’s respiratory system. If staff get COVID-19 and die, they become a statistic and work goes on as usual. The examples listed above are all safety issues for patients and staff but, like me, my colleagues are being ignored and informed "it's a business!" when these safety concerns are raised at the hospital. The only difference is they are permanent staff and their shifts cannot be blocked whereas I was a locum nurse who found my shifts blocked after I spoke up. Why has it been allowed to carry on? Why is there no Freedom To Speak Up Guardian at the hospital? Why has nothing been done? We can all learn from each other and we all have a voice. Sir Francis said we need to "Speak Up For Change", but management continues to be reactive when we try to be proactive and initiate change. This has to stop! Actions needed We need unannounced inspections from the Care Quality Commission (CQC) and HSE when we make reports to them. Every private hospital must have an infection control team and Freedom To Speak Up Guardian in post. -
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10,000 feet - Patient Safety in the operating theatre
Claire Cox posted an article in Process improvement
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Content ArticleFrom the 5365 operations, 188 adverse events were recorded. Of these, 106 adverse events (56.4%) were due to human error, of which cognitive error accounted for 99 of 192 human performance deficiencies (51.6%). These data provide a framework and impetus for new quality improvement initiatives incorporating cognitive training to mitigate human error in surgery.
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Remove central lines supine - animation (2017)
Claire Cox posted an article in Implementation of improvements
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Hywel Dda cancels operations after 'critical pressures'
Patient Safety Learning posted a news article in News
A health board has cancelled planned operations at four of its hospitals "in the interest of patient safety". Hywel Dda University Health Board made the decision after "an extraordinary weekend" of "critical pressures". On Monday, inpatient operations were cancelled at Bronglais, Glangwili, Prince Philip and Withybush hospitals in mid and west Wales. The health board said it had contacted the patients affected and outpatient appointments continued as normal. No decisions have been taken yet to cancel more non-emergency operations on Tuesday, it added. Dr Philip Kloer, the health board's medical director, said the weekend saw hospitals "at a level of escalation not seen before". "It is in the interest of patient safety that we have postponed planned operations today," he added. Plaid Cymru's shadow minister for health, Helen Mary Jones, said the decision to cancel operations was "deeply concerning". She said that patients in Wales "deserve so much better". Read full story Source: BBC News, 6 January 2020
