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Patient Safety Learning

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  1. Patient Safety Learning
    Hospitals in England have recorded more than 450 sewage leaks in the last 12 months, data shows, putting patients and staff in danger and prompting warnings that the NHS estate is “falling apart” after a decade of underinvestment.
    Freedom of information requests to NHS trusts by the Liberal Democrats found alarming examples of sewage leaking on to cancer wards, maternity units and A&E departments. The investigation also uncovered multiple cases of urine and faeces flowing into hospital rooms and on to general wards.
    Health officials called the revelations shocking. In some instances, sewage leaks made entire hospital departments unsafe for patients and led to staff struggling to work because they felt nauseous and had headaches.
    Ed Davey, the Liberal Democrat leader, said: “This is a national scandal. Our country’s hospitals are falling apart after years of underinvestment and neglect. Patients should not be treated in these conditions and heroic nurses should not have the indignity of mopping up foul sewage.”
    “At every turn, our treasured NHS is crumbling, from hospital buildings to dangerous ambulance wait times. The government needs to find urgent funds to fix hospitals overflowing with sewage. Patient and staff safety is a risk if ministers fail to act,” he said.
    Read full story
    Source: The Guardian, 17 February 2023
  2. Patient Safety Learning
    Workforce problems in US hospitals are troublesome enough for the American College of Healthcare Executives to devote a new category to them in its annual survey on hospital CEOs' concerns. In the latest survey, executives identified "workforce challenges" as the number one concern for the second year in a row.
    Although workforce challenges were not seen as the most pressing concern for 16 years, they rocketed to the top quickly and rather universally for US healthcare organisations in the past two years. Most CEOs (90%) ranked shortages of registered nurses as the most pressing within the category of workforce challenges, followed by shortages of technicians (83%) and burnout among non-physician staff (80%). 
    Read full story
    Source: Becker Hospital Review, 13 February 2023
  3. Patient Safety Learning
    Thousands of severely disabled children's lives are at risk because of long waits for ambulances, doctors and other experts have warned.
    Emergency care is a vital part of their everyday lives, the British Academy of Childhood Disability says. 
    Almost 100,000 children have life-limiting conditions or need regular ventilator support in the UK. They often rely on ambulances as part of their healthcare plan, because their condition can become life-threatening in an instant.
    Dr Toni Wolff, who chairs the British Academy of Childhood Disability, told BBC News some families with severely disabled children had "what are essentially high-dependency units" of medical equipment at home.
    "As part of their healthcare plan, we would normally say, 'If the child starts to deteriorate, call for an ambulance and it will be there within 10 or 20 minutes,'" she said.
    "Now, we can't give that reassurance."
    Despite their child being classed as a priority, parents have told BBC News they face the difficult decision to wait for an ambulance or take them, often in a life-threatening condition, to hospital themselves - a risk because of the huge amounts of equipment needed to keep them alive,
    Read full story
    Source: BBC News, 16 February 2023
  4. Patient Safety Learning
    Most health claims on formula milk products have little or no supporting evidence, researchers have said, prompting calls for stricter marketing rules to be introduced worldwide.
    Millions of parents use formula milk in what has become a multibillion-dollar global industry. But a study published in the BMJ has found most health and nutritional claims about the products appear to be backed by little or no high-quality scientific evidence.
    “The wide range of health and nutrition claims made by infant formula products are often not backed by scientific references,” said Dr Ka Yan Cheung and Loukia Petrou, the joint first co-authors of the study. “When they are, the evidence is often weak and biased.”
    Dr Daniel Munblit and Dr Robert Boyle, senior co-authors for the study, added: “There is a clear need for greater regulation and oversight to ensure that these claims are supported by sound scientific evidence and to protect the health and wellbeing of our youngest and most vulnerable populations.”
    Read full story
    Source: The Guardian, 15 February 2023
  5. Patient Safety Learning
    A government review into mental health hospitals will fail to prevent the “appalling” treatment of patients, campaigners have warned.
    The urgent inquiry into inpatient mental health services will focus solely on data, the government said on Tuesday.
    The “rapid review”, launched following investigations by The Independent into “systemic abuse” across a group of children’s mental health hospitals, will last 12 weeks and is being led by a former national NHS mental health director Dr Geraldine Strathdee.
    In an outline of what it will cover, the Department for Health and Social Care said it would look at what data is collected by the NHS on inpatient mental health services and whether it is used effectively to identify patient safety problems.
    It will also look at the quality of data and identify good examples of care but it won’t look at individual cases of abuse or community services.
    Major mental health charity Mind has warned the review “is not enough” and will not provide any learnings on how to prevent poor care. The charity is instead calling for a national statutory public inquiry into inpatient mental health services.
    Read full story
    Source: The Independent, 15 February 2023
  6. Patient Safety Learning
    "It would be much better if I was out there than in here," said Roger.
    The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital in Wales.
    He has been here for three weeks after being admitted with an infection and although he is now well enough to leave, and desperate to do so, he can't.
    Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home.
    Roger is not alone.
    "At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital.
    "It is very much a waiting game for that care to be available," she said.
    Hospitals in Wales are fuller than ever, according to the latest statistics. In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded.
    Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital.
    "Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said.
    Read full story
    Source: BBC News, 16 February 2023
  7. Patient Safety Learning
    The number of overheating incidents in clinical areas reported by NHS trusts has almost doubled over the last five years, with directors saying ageing estates make them vulnerable to extreme weather events.
    Providers reported that temperatures went above 26°C – the threshold for a risk assessment – more than 5,500 times in 2021-22, according to official data.
    Overheating looks set to become an increasingly significant issue for NHS estates, HSJ was told, as climate change makes extreme weather events more frequent and more intense.
    Janet Smith, head of sustainability at Royal Wolverhampton and Walsall Healthcare Trusts, said: “We’re feeling it now. And it’s not going to change unless we do something about it. We need a climate resilient estate to actually deliver sustainable care.”
    An overheating incident is when the temperature surpasses 26°C in an occupied ward or clinical space in a day, with each area counting as a separate incident. When this happens, trusts should carry out a risk assessment and take action to ensure the safety of vulnerable patients.
    Read full story (paywalled)
    Source: HSJ, 16 February 2023
  8. Patient Safety Learning
    Rising numbers of patients in England are failing to collect their medicines or asking pharmacists which ones they can “do without” because they cannot afford prescription charges, a survey shows.
    NHS prescriptions are free in Scotland, Wales and Northern Ireland. In England there are exemptions for certain items, medical conditions and specific parts of the population, but most adults have to pay. The current prescription charge is £9.35 an item.
    “We are deeply concerned that people are having to make choices about their health based on their ability to pay,” said Thorrun Govind, a pharmacist and chair of English pharmacy board of the Royal Pharmaceutical Society (RPS), which conducted the survey. “No one should have to make choices about rationing their medicines and no one should be faced with a financial barrier to getting the medicines they need.”
    The findings, from a survey of 269 pharmacies, prompted the RPS to renew its call for patients with long-term conditions in England to get free prescriptions. Charges create a financial barrier to accessing medicines needed to stay well, it said.
    Read full story
    Source: The Guardian, 13 February 2023
  9. Patient Safety Learning
    A new way of screening ambulance calls is to be introduced across England in an effort to improve response times.
    NHS England is asking ambulance crews to review which emergency calls other than those classed as immediately life threatening can be treated elsewhere.
    The calls - known as category two - include emergencies such as heart attacks and strokes. But the category also covers some that may not need such a fast response, such as burns and severe headaches.
    About 40% of these lower priority calls classed as category two by call handlers will now receive callbacks from a doctor, nurse or paramedic to see whether there is an alternative to sending an ambulance.
    In trials in London and across the West Midlands, nearly half of those receiving a callback were advised to go instead to an urgent treatment clinic, their GP or a pharmacist. NHS England is now asking the other eight ambulance services in England to adopt the approach. 
    Read full story
    Source: BBC News, 16 February 2023
  10. Patient Safety Learning
    The NHS has signed a £20m deal to enable health-service organisations to deploy technology to help better manage the spread of infections.
    The contract – awarded to US-based healthcare giant Baxter – is intended to offer NHS trusts a means through which they can buy a comprehensive infection-control platform. According to newly published commercial information such a system would, in many cases, replace various specialist software programmes used by NHS trusts to collect and process data, alongside spreadsheets and paper documents.
    “The system will support infection prevention and control activities to identify critical issues, proactively respond to improve the quality of care and streamline processes to reduce time spent on administrative and reporting tasks,” the contract notice said. 
    “Most NHS Trusts tend to manage infection control surveillance through the use of various systems, collating laboratory, patient and surgery data and manually searching through the data to identify patients of interest or complex scenarios. Paper and excel spreadsheets are also used to record and manage surveillance. This process is time consuming and risk of error.  NHS trusts are finding that they do not have a robust infection control system to monitor and manage their patients.”
    Read full story
    Source: Public Technology, 15 February 2023
  11. Patient Safety Learning
    About 2 million people die a year as a result of a core group of fungi, and the WHO is concerned we are unprepared for the future.
    In October, the World Health Organization released its fungal priority pathogens list, the first global effort to create a mycological “most wanted” list of the 19 fungi most dangerous to humans . “Despite posing a growing threat to human health, fungal infections receive very little attention and resources globally,” the report said. “This all makes it impossible to estimate the exact burden of fungal infections, and consequently difficult to galvanise policy and programmatic action.”
    Fungi are the most populous life form on the planet, with an estimated 12 million species existing worldwide. Only a fraction of these species infect humans, but they are responsible for roughly a billion infections each year. “Most of those are superficial things like athlete’s foot, that no one’s particularly bothered about, but there is a core group that causes life-threatening infections, and particularly in susceptible populations such as the very old or young, and those with immune systems that don’t work properly,” says Mark Ramsdale, an associate professor of mycology at the MRC Centre for Medical Mycology in Exeter.
    About 1.5 million people die a year as a result of these infections, says Ramsdale – although that may be an underestimation, because fungi predominantly infect people who already have major health problems. “The primary cause of death will probably be leukaemia or heart transplant, or whatever,” he says. “But the thing that actually kills the patient is a fungal infection, so there is a strong element of underreporting going on.”
    Underestimating them would be a mistake.
    Read full story
    Source: The Guardian, 10 February 2023
  12. Patient Safety Learning
    A high-profile £250m government intervention to free up hospital beds has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases.
    Steve Barclay announced the fund, including £200m to buy step-down residential care beds to speed up discharges, on 9 January, following a “recovery forum” crisis summit at 10 Downing Street.
    NHS England said in guidance on 13 January the funding must bring “immediate improvements”, and local leaders were again told to “maximise the impact of their areas’ allocation of the money in the run up to strikes on 6 February”. 
    But according to official data, in the week the new money was announced, there was an average of 14,035 patients who did not meet the clinical “criteria to reside”, but were still waiting to leave hospital, equating to around one in seven occupied beds. The total numbers have barely changed since then, with an average of 13,975 cases reported in the week to 5 February, also representing one in seven occupied beds.
    Read full story (paywalled)
    Source: HSJ, 13 February 2023
  13. Patient Safety Learning
    A damning report last year from Dr Hilary Cass into the Tavistock Gender Identity Development Service (GIDS) found that it was putting children at “considerable risk”. Her full report is due to be published later this year.
    Whistleblower Dr Anna Hutchinson, a senior clinical psychologist at GIDS, describes when she realised something was very wrong.
    “I just couldn’t comfortably keep being part of a process that was, I felt, putting children — but also my colleagues — at risk,” Hutchinson explains. Faced with no discernible action from the executive, staff began to look for other ways to raise their concerns, to other people who might listen — and act. Hutchinson approached the Tavistock’s Freedom to Speak Up guardian. At least four other colleagues did the same in 2017. That same year, another four clinicians took their concerns outside GIDS to the children’s safeguarding lead for the Tavistock trust."
    Read full story (paywalled)
    Source: The Times, 13 February 2023
  14. Patient Safety Learning
    Emergency patients are being left open to abuse when they are at their most vulnerable because of a lack of vetting of ambulance workers, watchdog officials have warned.
    One watchdog official warned that abusers would even seek out work as a paramedic because it provided an “attractive environment” for exploitation.
    Figures show that dozens of ambulance workers have faced action over sexual assault in the past two years, while paramedics account for one in three cases of tribunal action against care professionals. But one survivors’ group warned the figures were just the “tip of the iceberg”.
    Paramedics who have been struck off in the past two years include one who performed a sex act in front of a patient, while another was handed a suspended prison sentence for possessing thousands of images of child pornography.
    Helen Vine, special adviser to the Care Quality Commission, told a recent webinar: “There is a small proportion of the population who are seeking to abuse our patients and the ambulance can be an attractive environment for that type of individual. One of the reasons for this is the ambulance sector is predominantly lone working … and ambulance services offer privileged often unsupervised access to patients who can be very vulnerable".
    She said the lack of checks meant offenders were able to move between providers, adding: “They test the waters and their behaviours ... if they are challenged, they will move on, however, if they are not challenged then they can hide in plain sight, and they are wearing a trusted uniform and given responsible access to that patient group.
    Read full story
    Source: The Independent, 12 February 2023
  15. Patient Safety Learning
    Ambulance staff will need to respond to category 2 calls during strike action under new government proposals.
    The Department of Health and Social Care has launched a consultation on minimum service levels in ambulance services. It comes as industrial action continues across the NHS and as legislation to ensure minimum services levels in key industries during strikes is making its way through Parliament. 
    The consultation document read: “Our proposal is that calls classed as life-threatening and emergency incidents would always receive an appropriate clinical response when there is strike action.
    “In England, currently, these calls are classified as category 1 (immediately life-threatening) and category 2 (emergency) calls…
    “On strike action days, some workers would continue their work to ensure that these calls can be answered and responded to appropriately to protect the life and health of patients.”
    The proposals added services must also have “adequate capacity and resourcing” in call control rooms, to ensure all emergency 999 calls to ambulance services were answered.
    Read full story (paywalled)
    Source: HSJ, 13 February 2023
  16. Patient Safety Learning
    Some of the country’s most senior NHS clinicians are earning a lucrative sideline running private firms that offer to cut waiting lists at their own hospitals, the Observer can reveal.
    Top consultants in Manchester, Sheffield and London are among directors of “insourcing” agencies that charge the health service to treat patients at weekends and evenings and have won millions of pounds of work.
    Some hold leadership roles at NHS trusts that have awarded contracts to their own companies, raising concerns about potential conflicts of interest.
    One deputy medical director jointly ran a firm that provided “insourcing” solutions to his own NHS trust before it was sold in a £13m deal last year. Other consultants have set up firms that they and their colleagues work shifts through themselves, often at rates above NHS price caps.
    The Centre for Health and the Public Interest, an independent thinktank,  called for a ban on such arrangements. The General Medical Council said current conflict of interest policies did not always deliver “the transparency and assurance that patients rightly expect”.
    Read full story
    Source: The Guardian, 12 February 2023
  17. Patient Safety Learning
    Nitrous oxide levels on Watford General Hospital's maternity suite far exceeded legal limits during peak periods, a BBC investigation has found.
    In February 2022, air monitoring showed levels of almost 5,000 parts per million (ppm) - 50 times what is safe.
    The hospital's trust said it had since installed machines to remove the gas.
    It was one of a number of nitrous oxide incidents reported by NHS trusts to the Health and Safety Executive (HSE), Freedom of Information data has shown.
    The HSE disclosed the details following a request for its notifications under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).
    There were 11 notifications to the HSE between August 2018 and December 2022 from seven NHS trusts and one private hospital in relation to nitrous oxide - almost all relating to maternity units.
    Monitoring has led to a string of NHS trusts suspending the use of Entonox - a mixture of nitrous oxide and air used to assist women in labour with pain relief.
    NHS bosses acknowledge there is "limited research on the occupational exposure to Entonox, and the long-term health risks this may pose", though at least one expert has played down the risk.
    But staff working in maternity units face uncertainty due to prolonged periods of time spent in affected areas, with particular concerns over Vitamin B deficiency due to exposure.
    Read full story
    Source: BBC News, 13 February 2023
  18. Patient Safety Learning
    Nurses in England are preparing to escalate their dispute with the government by involving staff from NHS A&E departments, intensive care and cancer wards in a series of 48-hour strikes.
    The Royal College of Nursing (RCN) is understood to be planning to announce walk outs for two consecutive days and nights, rather than limiting action from 8am to 8pm as they have done so far.
    NHS leaders warned the looming strike could be the “biggest impact” on patients yet seen, with the union preparing to end a process where the RCN had agreed to exemptions with hospitals.
    The RCN told NHS leaders on Friday it is preparing to step up its dispute by asking its members working in emergency departments, intensive care units and oncology to join the strike.
    But the union, expected to announce the strike this week, will make a very limited set of provisions for the most urgent clinical situations as part of a legal obligation not to endanger life.
    Saffron Cordery, deputy chief executive at NHS Providers said: “A continuous 48-hour strike that includes staff from emergency departments, intensive care units and cancer care services would likely have the biggest impact on patients we’ve seen.”
    Read full story
    Source: The Independent, 12 February 2023
  19. Patient Safety Learning
    A health watchdog has issued an unprecedented warning over patient safety, culture and leadership at a scandal-hit NHS trust,The Independent has learned.
    The Parliamentary Health Service Ombudsman, the government body that investigates patients’ complaints, has used powers for the very first time to raise “serious concerns” about University Hospitals Birmingham Foundation Trust.
    The body does not have its own powers to intervene but the warning has triggered an investigation by NHS England.
    Ombudsman Rob Behrens said there needed to be “significant improvements” in culture and leadership at the trust. He also raised concerns that the trust had failed to “fully accept or acknowledge” the impact of findings from investigations on patient safety.
    The decision to trigger the alert, known as the emerging concerns protocol, was “not taken lightly”, Mr Behrens said.
    Read full story
    Source: The Independent, 12 February 2023
  20. Patient Safety Learning
    President Biden has endorsed “harm reduction,” which aims to cut down on overdoses by encouraging safer drug use. But the organizations carrying out that strategy are severely underfunded.
    In his State of the Union address on Tuesday, Mr Biden, the first president to endorse the strategy, highlighted the federal government’s attention to some of the core features of harm reduction work, including a provision in a recently enacted spending package that makes it easier for doctors to prescribe buprenorphine, an effective addiction medication that Ms Krauss works to get to drug users. During his speech, Mr Biden recognised the father of a 20-year-old from New Hampshire who died from a fentanyl overdose, citing the more than 70,000 Americans dying each year from the potent synthetic opioid.
    But two years after Mr Biden took office, with the nation’s drug supply increasingly complex and deadly, the practice of harm reduction remains underfunded and partially outlawed in many states.
    Read full story (paywalled)
    Source: New York Times, 10 February 2023
  21. Patient Safety Learning
    CVS Health confirmed last year it was closing half its Coram home infusion branches and firing about 2,000 nurses, dietitians and pharmacists.
    Their patients with life-threatening digestive disorders depend on parenteral nutrition, or PN — in which amino acids, sugars, fats, vitamins and electrolytes typically are pumped through a catheter into a large vein near the heart.
    A day later Optum Rx, another big supplier, announced its own consolidation. Suddenly, thousands were scrambling for their complex essential drugs and nutrients.
    “With this kind of disruption, patients can’t get through on the phones. They panic,” said Cynthia Reddick, a senior nutritionist laid off last summer in the CVS restructuring.
    “It was very difficult. Many emails, many phone calls, acting as a liaison between my doctor and the company,” said Elizabeth Fisher Smith, a 32-year-old public health instructor in New York, whose Coram branch closed. A rare medical disorder has forced her to rely on PN for survival since 2017. “It added to my mental burden,” she said
    Home and outpatient infusions in the USA are a growing business, as new drugs for chronic illness expand treatment options and enable patients, providers and insurers to avoid hospitalisation. 
    But while reimbursement for expensive new drugs has attracted corporations and private equity, the industry is constrained by a lack of nurses and pharmacists. The less profitable parts of the business — and the vulnerable patients they serve — are at risk. This includes the 30,000-plus Americans who rely on parenteral nutrition — including premature infants, post-surgery patients and those with damaged bowels because of genetic defects.
    Read full story (paywalled)
    Source: The Washington Post, 6 February 2023
  22. Patient Safety Learning
    A draft NHSE statement suggests mental trusts could be asked to eradicate features of the ‘serenity integrated mentoring’ (SIM) care model from clinical practice, following a whirlwind of concerns in 2021 and an investigation by national clinical director Tim Kendall.
    A core feature of SIM is to place a police officer within a healthcare team charged with supporting patients who frequently attend emergency services in crisis, and creating crisis plans.
    The draft position statement produced by NHSE, which the regulator said is not its final version and is subject to changes, says SIM should not be used.
    It also proposes the eradication of the following practices from any equivalent care model:
    Police involvement in delivery of therapeutic interventions in planned, non-emergency, community mental healthcare; The use of coercion, sanctions (criminal or otherwise), withholding care and otherwise punitive approaches; and Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed “high intensity users”. The statement, which is the first indication of NHSE’s position on the SIM model but not its final stance, also suggests Professor Kendall will be seeking assurance from trust medical directors that SIM or similar models, and the above three features of concern, are no longer used. A full policy and public statement on the model is expected by the spring.
    The StopSIM coalition, whose campaigning prompted the NHSE review, said: “Unless and until the full policy is freely available to service users and the public, service users are not equipped to protect themselves against the dangers of SIM and similar approaches".
    Further reading on the hub:
    The High Intensity Network (HIN) approach and SIM model for mental health care and 'high intensity users' – views and discussion
    StopSIM: Mental health is not a crime
     
  23. Patient Safety Learning
    Children suffering mental health crises spent more than 900,000 hours in A&E in England last year seeking urgent and potentially life-saving help, NHS figures reveal.
    Experts said the huge amount of time under-18s with mental health issues were spending in A&E was “simply astounding” and showed that NHS services for that vulnerable age group were inadequate.
    Children as young as three and four years old are among those ending up in emergency departments because of mental health problems, according to data obtained by Labour.
    Dr Rosena Allin-Khan, the shadow mental health minister, who is also an A&E doctor, said: “With nowhere to turn, children with a mental illness are left to deteriorate and reach crisis point – at which time A&E is the only place left for them to go. Emergency departments are incredibly unsuitable settings for children in crisis, yet we’re witnessing increasingly younger children having to present to A&E in desperation.”
    Young people who endured long A&E waits included those with depression, psychosis and eating disorders as well as some who had self-harmed or tried to kill themselves, doctors said.
    Read full story
    Source: The Guardian, 9 February 2023
  24. Patient Safety Learning
    A woman who underwent needless surgery at the hands of convicted surgeon Ian Paterson said patient safety was still not being prioritised.
    Paterson was convicted of 17 counts of wounding with intent in 2017 and was jailed for 20 years.
    Debbie Douglas, who now campaigns for his victims, said more still needed to be done following a damning report.
    In December, the Department for Health said it was making "good progress" on changes.
    The inquiry, published in 2020, made 15 recommendations and Ms Douglas called on health chiefs to "get on" with the improvements.
    "It's three years and technically none of the recommendations are closed," she said.
    "It's all around patient safety and it's not being given the priority it deserves."
    Read full story
    Source: BBC News, 9 February 2023
  25. Patient Safety Learning
    Changes to hip and knee surgery could halve waiting lists at one hospital within a year, say doctors.
    Tweaks to surgeries at the Princess of Wales hospital in Bridgend have allowed more patients to be sent home on the same day. Therefore, a shortage of hospital beds is not a barrier for them.
    It comes as over 37,000 orthopaedic patients are waiting over one year for surgery in Wales.
    Consultant orthopaedic surgeon Keshav Singhal said a number of "minor tweaks" were made to the procedure "but all of them add up to a huge effect".
    He said the anaesthetic and pain medication given to patients is "fine-tuned" to reduce pain and nausea after the operation and extra time is spent pinpointing any potential area of bleeding and cauterising it to "prevent wound leakage".
    "In day surgery we are not constrained by beds - there are no beds here," said Mr Singhal.
    "Patients can come in, be very well cared for in a state of the art day-surgery unit, and go home in the evening, and that totally cuts down on the inpatient beds."
    Read full story
    Source: BBC News, 10 February 2023
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