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Surgical teams are under growing pressure, from rising case complexity and elective backlogs to increasing care demands and system fragmentation. But is it possible to redesign surgical pathways to improve both outcomes and efficiency? And what does good clinical pathway management really look like? On Wednesday 16 April 2025, Surgery International will host a free online webinar exploring the future of clinical pathway management through the lens of perioperative medicine. The session will bring together leading voices in surgery and digital health to explore how we can build safer, smarter and more connected surgical pathways, without losing sight of individual patient needs. Register

Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. The importance of fall prevention extends beyond patient safety—it reduces hospital liability, enhances patient outcomes and improves overall healthcare efficiency. By proactively assessing and addressing fall risks, healthcare providers can significantly lower the incidence of falls, ensuring a safer environment for patients. Given the aging population and increasing chronic disease burden, fall prevention remains a top priority in improving patient care and quality of life. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings. Introduction Falls among patients, particularly in healthcare facilities, remain a pressing concern worldwide. These incidents not only lead to injuries, prolonged hospital stays and increased healthcare costs, but can also have lasting psychological impacts on patients. Preventing patient falls necessitates a multifaceted approach, with fall risk assessment at its core.[1] Understanding the impact of patient falls Patient falls are defined as unintentional descents to the ground that occur in healthcare facilities, including hospitals, nursing homes and rehabilitation centres. According to the World Health Organization (WHO), falls are the second leading cause of unintentional injury deaths globally, with older adults being most at risk.[2] In healthcare facilities, the consequences of falls extend beyond physical injuries; they also affect a patient’s confidence, independence, and quality of life. The financial burden of falls on healthcare systems is substantial. Costs include direct expenses such as treatment for fall-related injuries and indirect costs like litigation, reputation damage and loss of trust. Additionally, healthcare providers experience emotional distress and professional repercussions when preventable falls occur under their watch. Hence, fall prevention is not just a patient safety priority but also an ethical obligation and a cost-saving measure. The role of fall risk assessment Fall risk assessment is a systematic process to identify patients at risk of falling. Healthcare providers can implement targeted interventions to mitigate these risks by evaluating intrinsic and extrinsic factors. Intrinsic factors include age, medical history, mobility impairments and cognitive status, while extrinsic factors encompass environmental hazards, medication side effects and inadequate assistive devices. Risk assessment tools, such as the Morse Fall Scale, Hendrich II Fall Risk Model and STRATIFY Risk Assessment Tool have been widely used. These tools provide a structured approach to assess risk levels and guide preventative measures. However, their effectiveness depends on accurate application and regular updates based on patient conditions. Implementing effective fall risk assessments To maximise the efficacy of fall risk assessments, healthcare facilities must adopt evidence-based strategies and integrate them into their workflows. Key steps include: Standardised assessment protocols: Developing and adhering to standardised protocols ensures consistency in evaluating fall risks across different departments and shifts. Protocols should specify the frequency of assessments, criteria for reassessment and documentation requirements. Staff training: Comprehensive training programme for healthcare workers are essential to enhance their competency in conducting fall risk assessments. Training should cover assessment tools, recognition of risk factors and communication of findings to the care team. Patient and family education: Involving patients and their families in fall prevention efforts fosters a collaborative approach. Educating them about potential risks and preventive measures empowers them to contribute to safety. Technology integration: Advanced technologies such as wearable sensors, predictive analytics and electronic health records (EHRs) can augment traditional fall risk assessments. For instance, sensors can monitor patient movements and alert staff to potential falls, while EHRs can flag high-risk patients for closer observation. Challenges in implementing fall risk assessments Despite its benefits, implementing fall risk assessments is not without challenges. Common barriers include: Resource constraints: Limited staffing, time pressures and inadequate funding can hinder comprehensive risk assessments. Overburdened staff may struggle to prioritise fall prevention alongside other responsibilities. Inconsistent application: Variability in applying risk assessment tools can lead to inaccurate results. Subjective judgment, incomplete data collection and lack of protocol adherence contribute to inconsistencies. Resistance to change: Resistance from staff and administrators to adopt new practices or technologies can impede the integration of fall risk assessments into routine care. Patient non-compliance: Some patients may resist interventions such as bed alarms, mobility aids or supervision, increasing their risk of falling. Strategies to overcome the challenges To address these challenges, healthcare facilities can adopt the following strategies: Leadership support: Strong leadership commitment is crucial to allocating resources, establishing accountability and creating a safety culture. Interdisciplinary collaboration: Engaging multidisciplinary teams, including nurses, physicians, physical therapists and pharmacists, ensures a holistic approach to fall risk assessment and prevention. Continuous Quality Improvement: Regular audits, feedback sessions and performance evaluations help identify gaps in fall prevention efforts and drive improvements. Tailored interventions: Personalising interventions based on individual patient needs and preferences increases their acceptability and effectiveness. Conclusion Preventing patient falls requires a proactive and comprehensive approach, with fall risk assessment as a foundational element. Healthcare facilities can significantly reduce fall-related incidents and their associated consequences by identifying at-risk individuals and implementing tailored interventions. However, the success of fall prevention efforts hinges on overcoming implementation challenges through leadership support, interdisciplinary collaboration and continuous improvement. As healthcare systems evolve, leveraging technology and prioritising patient-centred care will be instrumental in advancing fall risk assessments. By embracing these advancements, healthcare providers can create safer environments that uphold all patients' dignity, independence, and well-being. References The Joint Commission. Fall Reduction Program - Definition and Resources, 28 August 2017 WHO. Falls Factsheet. World Health Organization, 26 April 2021.

When someone needs a joint replacement, there are many factors that affect how well they will respond, how quickly they will recover from the procedure and the potential risks of surgery. Patient complexity is the term used to describe these factors and includes other health conditions, sometimes called co-morbidities, as well as local risk factors related to the specific joint needing to be replaced. In this interview, consultant orthopaedic surgeon Sunny Deo and engineer and founder of TCC-Casemix Matthew Bacon, discuss how new technology is allowing surgeons to more accurately predict the surgical risk and outcomes for patients having knee replacement surgery. They describe how a new approach to data modelling is allowing the orthopaedic team at Great Western Hospital NHS Foundation Trust to more accurately assess complexity for individual patients. This has benefits for patient care and outcomes, theatre productivity and the development of pathways that are more patient-centred. They also highlight some patient safety issues associated with elective surgical hubs, which were set up to deal with high volume low complexity patients, including the deprioritising of more complex patients who may be at greatest need of surgery. Finally, they discuss the applicability of this approach to other specialties and areas of healthcare. Read more about clinical complexity in joint replacement surgery in this presentation by Sunny Presentation - Overview of clinical complexity by Sunny Deo.pdf

Claire Cox, Patient Safety Lead at Kings College Hospital NHS Foundation Trust, shares a recent technique she used to explain the difference between 'work as imagined' and 'work as done'. Claire's example (a pathway for a patient coming to A&E, who also has a mental health issue) highlights the safety risks of competing guidance and the importance of co-production moving forward. The phrase work as imagined vs work as done is often used within patient safety but it's not always an easy concept to explain. I recently tried a new tactic to bring the realities of this concept to life, and show why it is so important to address these issues - in this case relating to a mental health pathway in A&E. My aim was to explain how some of the policies we try to use don't actually work well together in practice when we have a patient come to A&E with a both a mental and physical health problem. I started off by printing every piece of policy, guidance, standard operating procedure, related documentation on the trust intranet, HSIB reports, NICE guidance and anything I could find from the wider NHS. I pinned it across the walls in the meeting room. There were more than 150 items relating to how we should care for the patient in these circumstances. We put the pathway that we 'imagined' at the top, like a process map along the wall. We then placed all of the policies and documents below the pathway at the relevant points. Then I got the staff to tell me what actually happens. It became clear very quickly that the policies contradict each other. In trying to follow two policies, you couldn't actually adhere to either one properly. It was impossible for staff. Once we did that exercise, participants in the room could see how the people writing policies did not perhaps understand how 'work is done'. So it was decided that any new policy that encompassed this mental health pathway for A&E would be co-written by patients, families and the staff doing the work. Importantly, this would include all staff involved - admin, clinical and management. Once that had been written it would go through stages of testing to make sure it was working well and to incorporate necessary flex in the system when unexplained or unintended things happen. We would look at and test the vulnerabilities within that system or process. The exercise took time and effort but it was an effective way to show people the challenges and barriers to safe care in a specific context. My advice to others trying to do the same would be to get it all out, expose it, make it as visible as possible. Sometimes you have to be the one to put the writing on the wall. Related reading Postcards from work: Exploring archetypes of human work through micro-narratives Work as is done, work as imagined Electronic observations – how safe is it? Proxies for work-as-done: a blog series by Steven Shorrock, Humanistic Systems Share your thoughts What did you think of Claire's example? Could you see this working in a different area of healthcare?Do you have any tips or techniques to share that could help others explain the challenges they face on the ground to large groups of people? Share your thoughts by commenting below (sign up here first for free), or get in touch with our content team at [email protected]

This webinar is part of the HSJ Elective Care Recovery Virtual Series. To clear the waiting list backlog, hospitals will need to drive more elective activity within capacity and resource constraints. It demands the need to think differently and to work differently, questioning assumptions about the ‘normal’ ways of doing things. In this session we’ll explore innovative ideas, digital interventions and transformation programmes designed to free up time in elective pathways. Key topics include: Patient-initiated follow-ups Reducing outpatient appointments Pre-operative transformation / digitisation Investing in digital tools to improve efficiency in elective care pathways Register

Kate Pym, Managing Director of Pym's Consultancy, discusses the barriers involved in getting an innovative product into the NHS. The NHS will not pay to improve patient safety You may think that I am saying this to be contentious, but sadly I am not. As an independent business consultant who supports new businesses and entrepreneurs in the health and care sector, this is a conversation which I have on almost a weekly basis. The reason for this is that most innovations are in response to a perceived problem, and there is no problem more obvious than harm caused to patient during medical treatment. The British are by nature innovative (36,558 Patent Applications were made by UK citizens in 2019, ranking in the top 10 worldwide in several indicators) and, for many people faced with a problem, their first response is to try and solve it, in this instance to prevent another patient from being harmed. This means that people have an idea, design, prototype or product, then find me to help them take the product to market and sell it. Unfortunately, many years of experience selling to the NHS across multiple organisations, from primary to tertiary care, has taught me that the NHS will not pay to improve patient safety. This applies even in the instance of never events – events that occur with the potential to harm patients, where if all guidelines and protocols are followed correctly this should never happen. My advice to innovators in patient safety I tell all prospective and current clients working in the field of improving patient safety to prove their concept in the UK, then sell overseas. An insurance-based health economy aligns the cost of patient harm and litigation with provision of healthcare and, as such, are risk-averse and highly motivated to provide the best possible levels of patient safety. The NHS system does not align costs and consequences of poor patient care with provision. Why won’t the NHS pay to improve patient safety? The NHS won’t pay because it is always the responsibility of somebody else’s budget. In all things commercial you have to look at motivation and reward. If, for example, a surgeon is the responsible clinician in theatres where a never event occurs, that surgeon will be held accountable and go through a rigorous investigation process to uncover the root cause. Although the investigation is not meant to be punitive, the sense of personal guilt, anxiety for the patient and family, and the potential for referral to governing bodies and even loss of their job, means that surgeons are very highly motivated to prevent never events. But the surgeon doesn’t hold the budget. If a piece of technology could prevent a never event in theatres, it would be the theatre manager who holds budgetary responsibility for purchase. However, the theatre budget is always fully accounted for; the NHS runs a very lean ship, and if an additional item is to be purchased something else is not – so what should be left out? PPE? Autoclave? Staff? Another point for the theatre manager is that, although they would be part of any investigation, they are not held responsible for an event and any consequential costs of extra bed days, rehabilitation and litigation are also not their responsibility. A real-life example... To give a real-life example, I consulted with Uvamed in 2016. They had an innovative product which reduced the risk of medication errors in anaesthesia. I conducted research to uncover the scale of the issue in the UK and in 2015 the Patient Safety Update from The Royal College of Anaesthetists (RCoA) reported 7,992 anaesthesia errors between April and June 2015 (yes, that’s right a quarter of a year), of these errors, 2,235 caused harm to patients, including 21 deaths and 22 severe harm. 13.5% of these errors were medication errors. In 2016 there had been a recent change in NHS Litigation Authority premiums paid by each NHS trust for Professional liability and negligence, using a claims history of 10 years instead of the previous 5 years, which meant that for some trust’s premiums had increased in excess of £2 million per year. This also meant that the litigation history of a trust would impact trust budget for 10 years. A freedom of information request to the NHS Litigation Authority uncovered the total number of anaesthesia claims received in 2014/15 to be 148; the total cost of settling the successful anaesthesia claims over the 10-year period was £140,962,157.17, £6,598,988.38 in the year ending April 2015. Anaesthesia is usually about a regular practiced routine. Standard practice is that syringes are prepared in advance of surgery and labels are applied to each according to strict colour coding, the syringes are then put in a receptacle (usually a cardboard kidney dish), with a second selection of prepared syringes in case of emergencies in theatre. Most errors involve human factors, such as tiredness or distraction, and in the heat of the moment it is easy to reach for a syringe in a jumble of other syringes and think that you have selected the right one, only for a different syringe to slip into your hand by mistake. Uvamed's product was Rainbow Trays®. Rainbow Trays consist of a base tray with coloured sections and disposable inserted trays, which are made of bacteriostatic plastic and have physical barriers between sections. The colour coding is the same as that used in critical care labelling for syringes, with sections in a logical progression for use. Unsurprisingly, anaesthetists loved them and wanted to trial and purchase. Trials went well and everyone was happy. The purchase had to come out of theatre budgets. The theatre managers saw no financial benefit to their department in return for the spend so they wouldn’t pay, neither would any other department. The happy ending for Uvamed and international healthcare is that Rainbow Trays® are “flying off the shelves” in the USA, Australia and New Zealand. Rainbow Trays are on NHS Supply Chain and have been purchased at quantity by Health & Social Care Northern Ireland for their Nightingale Hospitals. For further information on Rainbow Trays, contact Keith Fawdington [email protected] Conclusion Unfortunately, NHS England will not pay to improve patient safety until either the silo mentality of internal budgets is removed (which is as likely as an effective fireguard made of chocolate) or someone at senior level in each trust is made accountable for the impact (financial and social) of unsafe patient care and given a budget to improve outcomes and reduce risks. Call for action Some forward-thinking Trusts have Board-level roles for Innovation. I appreciate that no Trust wants a senior member of staff 'bothered' by every good idea out there, but with a triage qualification for appointments this could offer the opportunity for our innovators to help the NHS improve care, efficiency and outcomes. Institute a team of clinicians and business managers who hold the responsibility for patient safety, making them responsible and accountable for seeking improvements in patient care (both internal and external). This would only work if they are allocated a budget, and a target of identifiable improvements. Other hub articles you may be interested in Why NHS procurement must change if we want to improve patient safety

WireSafe® is an innovative solution designed to prevent retained guidewires during central venous catheter (CVC) insertion. Retained guidewires are never events that require urgent removal if accidentally left in. They occur in about 1 in 300,000 procedures. We interviewed Maryanne, who developed the WireSafe®, on the innovation, the human factor considerations in designing it and the difficulties she faced getting a new product into the NHS.