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Showing results for tags 'Handover'.
Found 115 results
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News Article
Ambulance handover delays still harming tens of thousands each month
Patient Safety Learning posted a news article in News
Tens of thousands of patients are still suffering harm from delays in ambulance handovers to emergency departments despite a concerted effort to tackle the problem, figures seen by HSJ indicate. The data shows more hours have been lost to handover delays lasting more than 15 minutes in most of the first five months of 2024 compared to the same period in 2023. In May, more hours were lost than in May 2022 and May 2023. The Association of Ambulance Chief Executives told HSJ the problem remained severe and the government needed to act to improve it. AACE managing director Anna Parry said it had consistently warned about the ongoing risk of handover delays. She said: “This is why one of our key requests of the new government has been that they proactively support the ambulance sector’s aim to ensure patients universally receive high-quality, timely care and no longer experience unacceptable delays in response or handover of care, for example, at hospital emergency departments. “This problem is not intractable. We have demonstrated that in areas where there is a strong leadership focus and true system-wide support, handovers can be managed effectively, despite the significant pressures and constraints our health and social care system is under. However, it remains vital that we see more demonstrations of excellent leadership to get to that point across the country.” Read full story (paywalled) Source: HSJ, 10 July 2024 -
Content Article
In early 2022, following his wishes, my husband was discharged from hospital for end of life care at home to be provided by his family (his wife, three adult children and son-in-law) and nurses from our local hospice. We were completely unprepared for the challenges and disruption that lay ahead for us all. -
News Article
Ambulance response warning after woman's death
Patient Safety Learning posted a news article in News
Long waiting times at hospitals in the north-west of England are putting patient's lives at risk by holding up ambulance crews, a coroner has warned. It comes after the death of Bobilya Mulonge, who called 999 with breathing problems on 24 November 2022. She waited 72 minutes for an ambulance - four times longer than North West Ambulance Service's (NWAS) 18-minute target for her category of emergency call - which "probably contributed to her death", coroner Lauren Costello said. A NWAS spokesman said the service was "very sorry" an ambulance was unable to attend sooner and the service had made "significant" improvements since. A report by Ms Costello has been sent to the health secretary and NWAS and urges the region's health authorities to take action to prevent further deaths. She said evidence about ambulance delays revealed during the inquest had given rise to her concerns. "In my opinion there is a risk that future deaths could occur unless action is taken," she wrote. Dale Ollier, north-west regional organiser for Unison, which represents some ambulance staff, said backlogs in moving patients out of hospitals was having a "knock-on effect" at A&E, leading to a "bottleneck crisis". “We have patients that could be safely discharged but there isn’t anywhere to discharge them to because of the lack of capacity in social care." Ambulances were working "flat out", he added, but delays had lead to an "unbearable demand" on crews who were sometimes "tied up for several hours" waiting at hospitals. Read full story Source: BBC News, 20 June 2024 -
Content ArticleOn 24 May 2023 an investigation was commenced into the death of Bobilya Mulonge then aged 62 years. The investigation concluded at the end of the inquest on 19 April 2024. The conclusion of the inquest was a narrative conclusion that Mrs Mulonge died as a result of congestive cardiac failure against a background of hypertensive heart disease. Ambulance response times probably contributed to her death. The medical cause of death being: 1 (a) Congestive Cardiac Failure (b) Hypertensive Heart Disease II) Chronic Kidney disease and Type II diabetes mellitus.
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News Article
Whole health system’s IT goes down
Patient Safety Learning posted a news article in News
HSJ understands that IT systems across the Cornwall and Isles of Scilly ICS went down around midday, prompting the declaration of a major incident. In a statement, a spokesperson for the ICS said the incident was a “local issue” and not a “cyber attack”. As a result of the issue, some planned outpatient appointments, including operations, have been cancelled. The outage is also thought to have contributed to a large ambulance handover backlog. Royal Cornwall Hospitals NHS Trust, Cornwall Partnership NHS Trust, and University Hospitals Plymouth NHS Trust, as well as GP surgeries and community providers, are understood to have been affected by the outage. Read full story (paywalled) Source: 11 June 2024 -
Content ArticleAmbulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised.
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News Article
Concerns at Nottinghamshire hospital after baby's sepsis death
Patient Safety Learning posted a news article in News
The parents of a baby who died from sepsis said their son deserved a "fighting chance" after concerns were raised over his care in hospital. Ten-week-old Tommy Gillman was admitted to King's Mill hospital on 7 December 2022 but died the next day. Tommy Gillman, from Coddington, Nottinghamshire, was "extremely unwell" with what proved to be Salmonella Brandenburg meningitis when admitted to the Sutton-in-Ashfield hospital at 12:35 GMT. His assessment was delayed, and then the severity of his condition missed, meaning correct treatment with antibiotics and fluids did not start until 17:00. A coroner's report identified a lack of experienced paediatric nurses and confusion in handovers between staff. "I am not reassured that necessary actions to address these serious issues identified are in place," the coroner said. Sherwood Forest Hospitals NHS Foundation Trust said it welcomed the review and a "rapid" programme of improvements was being worked on. Tamzin Myers and Charlie Gillman said their son deserved "a fighting chance" by getting prompt treatment Read full story Source: BBC News, 17 April 2024 -
Content ArticleTommy Gillman died on 8 December 2022 from sepsis and multi organ failure secondary to Salmonella Brandenburg meningitis. There were missed opportunities to provide him with earlier antibiotics, fluid resuscitation and intensive monitoring from 12.35pm on the 7 December 2022 at Kings Mill Hospital. Once the severity of his illness had been recognised at approximately 17:00 hours on that day, he was provided with prompt treatment for septic shock and meningitis. Sadly however he did not respond to this treatment and died the following day following transfer to Leicester Royal Infirmary. Whilst there were serious missed opportunities to provide earlier treatment of sepsis and meningitis.
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News Article
Doubling of average waits for critical stroke treatments
Patient Safety Learning posted a news article in News
Stroke patients in England are waiting an average of almost seven hours for a specialist bed, double the wait reported before Covid. National performance against key measures collected by the Sentinel Stroke National Audit Programme has nosedived, with patients in England waiting an average of almost seven hours to be admitted to a specialist unit in 2022-23, compared to three and a half hours in 2019-20. NHS England guidance states that every patient with acute stroke should be given rapid access to a stroke unit within four hours. This time frame is considered critical, as patients can only be given clot-busting drugs, and treatments such as thrombectomy, which surgically removes a clot, within the first few hours of stroke onset. However, this was achieved in just 40% of cases last year (2022-23), down from 61% in 2018-19. Juliet Bouverie, CEO of the Stroke Association, urged ministers to give trusts what they needed to reverse the decline, saying: “Stroke is a medical emergency and every minute is critical. “We are very concerned to see that, far from improving over the last year, the proportion of stroke patients being admitted to a stroke ward within the timescale for thrombolysis has continued to decline. This is putting patient recoveries at risk and strain on the rest of the health system. “We believe that early supported discharge, when done correctly, with adequately resourced community teams, can help to alleviate capacity pressures in acute stroke units. However, this is not a silver bullet. There are longstanding workforce issues which are affecting patient flow in, through and out of stroke units and we call on DHSC to properly address these in the workforce plan.” Read full story (paywalled) Source: HSJ, 2 January 2024 -
Content ArticleRob Behrens reflects on the work the Parliamentary and Health Service Ombudsman (PHSO) has done over the last year to drive improvements in patient safety.
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News Article
Ambulance handover delays soar as winter bites
Patient Safety Learning posted a news article in News
Ambulance handover delays rose last week with close to 13,000 crews waiting more than an hour to offload patients — marginally more than the comparable week last year. Week of 27 November 2023 figures were missing data for several days from some trusts, NHSE said. The number of hour-plus waits for ambulancs to pass patients to emergency departments was 12,797, according to new NHS England data. That appeared to be steeply up from about 8,000 in the past two weeks, although NHSE said last week’s was not directly comparable due to missing data. It was just ahead of the 12,534 recorded for the week ending 11 December last year. Last year the numbers rose to over 16,000 in the third week in December then peaked at 18,720 in the week running up to New Year, in what many said was the worst winter crisis for decades, amid a sharp, early wave of flu. This year the numbers of long waits have risen earlier than last, and several ambulance trusts have reported coming under severe pressure in the last few days. NHS England has warned junior doctors strikes next week and in the new year may compound hospital flow problems. Read full story (paywalled) Source: HSJ, 15 December 2023 -
News Article
Ditch normal procedures to avoid A&E handover delays, trusts told
Patient Safety Learning posted a news article in News
Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays. In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”. The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls. The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working. “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.” Read full story (paywalled) Source: HSJ, 11 December 2023 -
News Article
Health secretary told to intervene over ‘systemic’ ambulance deaths
Patient Safety Learning posted a news article in News
Ministers must intervene over systemic failures which are “too big for hospital or ambulance trusts to fix on their own” and have led to multiple preventable deaths, a senior coroner has warned. In a move usually considered rare for such an official, Cornwall and Isles of Scilly coroner Andrew Cox has written to the Department of Health and Social Care a second time over ongoing delays to ambulance responses and long ambulance handovers in the area. Last year he warned the NHS was “broken” after he ruled ambulance and emergency care delays contributed to the deaths of four people. Now, he has sent a similar report on the same types of failings in the deaths of John Seagrove, Pauline Humphris, and Patricia Steggles at Royal Cornwall Hospital to new health secretary Victoria Atkins. Mr Cox wrote: “I set out in my [prevention of future death report] last year my understanding of the reasons for the difficulties that are continuing in the Cornwall & Isles of Scilly coroner area. I do not believe those reasons will have changed significantly. ”The challenges are systemic in nature. They are too big for a single doctor, nurse or paramedic to fix. They are too big for either the hospital trust or the ambulance trust to fix on their own.” Read full story Source: HSJ, 1 December 2023 -
News ArticlePatient safety is being put at risk by the “toxic” behaviour of doctors in the NHS, the health ombudsman has said. Rob Behrens, who investigates complaints about the NHS in England, warned that the hierarchical and high-handed attitude of clinicians was undermining the quality of care in some hospitals. He called for medical training to be redesigned to encourage a more empathetic and collaborative approach from doctors. Pointing to failings in the treatment of sepsis and the problems in maternity services, Behrens said he was “shocked on a daily basis” by what he saw as ombudsman. Too often, “organisational reputation has been put above patient safety”, he told The Times Health Commission. The ombudsman warned of a “Balkanisation” of health professionals, with rivalries between doctors and nurses or midwives and obstetricians harming patient care. “For all the brilliance of clinicians quite often they’re not very good at working together,” he said. “Time and again, the handover from one clinician to another, from one shift to another, or the inability to raise the issue at a senior level has been a key factor in what has gone wrong.” Read full story (paywalled) Source: The Times, 18 November 2023
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News Article
Ward staff ‘must accept extra workload to help A&E’
Patient Safety Learning posted a news article in News
Hospitals are being prevented from adopting models which spread risk away from emergency departments because other teams refuse to take on the extra work, according to a top accident and emergency doctor. In a recent interview with HSJ, North Bristol Trust chief executive officer Maria Kane praised her trust’s risk-sharing approach to emergency care, which involves moving patients each hour from accident and emergency to the most appropriate ward for their needs and where a discharge is expected, even if it is full. Commenting on the article, Royal College of Emergency Medicine president Adrian Boyle said: “The NBT trust leadership deserve significant credit for maintaining this. All too often there is an acceptance of unacceptable delays (and risk) in ambulance handovers and long ED stays. “Where this fails, it is usually because inpatient teams (both nursing and medical) have objected to the extra workload, without appreciating the real harm elsewhere. The more interesting question is why isn’t this being done more widely?” Read full story (paywalled) Source: HSJ, 15 November 2023 -
News Article
A&E handover delays ‘still getting worse at some hospitals’
Patient Safety Learning posted a news article in News
Ambulance chiefs say handover delays have got worse at some trusts in recent months, despite the picture improving nationally since last winter. A report from the Association of Ambulance Chief Executives says there are continuing concerns about handover delays at emergency departments. Jason Killens, the body’s lead chief executive for operations, told HSJ: “There’s been some improvement [at some sites] since February, but what we’ve also seen is a commensurate or bigger decay in other sites across that same period.” Mr Killens said “it’s difficult to be precise” about why some trusts have struggled more than others but that challenged hospitals are often affected by “pathway issues” including delayed discharges. “And then maybe there are challenges around stable leadership or the visibility of the leadership, the culture there about managing that risk dynamically, and so on,” he added. Read full story (paywalled) Source: HSJ, 14 September 2023 -
Content ArticleThe Association of Ambulance Chief Executives (AACE) has published a new report charting the major increase in the frequency and length of hospital handover delays over the past ten years, calling for an even greater focus on improvements that will reduce and eradicate delays, prevent more patients from coming to significant harm and stop the drain on vital ambulance resources.
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Content ArticleOn the 20 February 2019 an investigation commenced into the death of Bethan Naomi Harris who was born on the 16 November 2018 at the St George's University Hospitals NHS Foundation Trust. Bethan Naomi Harris died at Shooting Star Hospice on the 26 November 2018. Her mother's pregnancy had been uneventful. After admission to labour ward labour progressed very quickly indeed and Bethan sustained severe brain injury during delivery. Despite best efforts by the neonatal team she succumbed to her injuries. The Investigation concluded at the end of the Inquest on the 19 November 2019. The conclusion of the inquest was that the medical cause of Bethan's death was (1a) hypoxic ischaemic encephalopathy.
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Content ArticleA casually centred proposal identifying how Fire and Rescue Services can improve pre-hospital care and quality of life outcomes for burn survivors. David Wales and Kristina Stiles have released this report looking at the burn survivor experience in the pre-hospital environment. The work makes ten operational recommendations and also two 'lessons learned' recommendations exploring strategic partnership working and the resulting fragmented services.
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Content ArticleHospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.
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Content ArticleThis white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
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EventThis Hospital at Night Summit focuses on out of hours care in hospitals delivering high quality safe care at night, and supporting the wellbeing of those working at night. Through national updates, networking opportunities and case studies this conference provides a practical guide to delivering a high quality hospital at night and transforming out of hours services and roles to improve patient safety. The 2023 conference will focus on the developing an effective Hospital at Night service, and focus on the practicalities of supporting staff at night, improving wellbeing and fighting fatigue. Benefits of attending this conference will enable you to: Network with colleagues who are working to improve Hospital at Night Practice. Learn from recent developments. Improve your skills in the recognition management and escalation of deteriorating patients at night. Understand and evaluate different models for Hospital at Night. Examine the role of task management solutions for Hospital at Night, including handover and eObservations. Ensure effective and safe staffing at night. Improving and supporting the wellbeing of hospital at night staff. Examine Hospital at Night team roles, competence and improve team working. Improve safety through the reduction of falls at night. Supporting staff and reducing fatigue at night. Develop the role of Clinical Practitioner and Advanced Nursing Practice at night. Identify key strategies to change practice and ways of working in Hospital at Night. Understand how hospitals can improve conditions for night workers and support Junior Doctors. Self assess and reflect on your own practice. Supports CPD professional development and acts as revalidation evidence. This course provides 5 Hrs training for CPD subject to peer group approval for revalidation purposes. Register hub members receive a 20% discount. Email info@pslhub.org for discount code.
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Content ArticleTraditional approaches to patient safety and handoffs need redesigning to acknowledge the different constraints, goals, and requirements necessary for each individual patient. There is no “one size fits all” approach to patient safety, handoffs or a perfect checklist. Despite the inherit complexity present in healthcare systems, we tend to reduce our thinking about handoffs into simple solutions of checklists and cognitive aids. In studies of these tools, their association with patient outcomes is unclear with mixed results in large studies. Incorporating general resilience engineering principles of visibility, understanding, anticipation, and learning provides new opportunities for increased patient safety. This involves situating the handoff in the context of the system - understanding the process of summarising pre-handoff and of developing understanding post-handoff, tracing flows of information and patients, and considering the role of feedback and control loops in the system. Direct observations, analysis of multiple outcomes, focus on patient evolving specific exceptions, reducing the number of handoffs, taking time for two-way discussions, and user-centred design and redesign may promote acceptability and sustainability of a new view of handoffs for improved patient safety.
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News Article
Thousands exposed to severe harm due to ambulance wait times last month
Patient Safety Learning posted a news article in News
Record numbers of patients suffered severe harm last month because they spent so long in the back of ambulances waiting to get into A&E, new NHS figures reveal. An estimated 57,000 people in England “experienced potential harm”, of whom 6,000 were exposed to “severe harm”, in December – both the largest numbers on record – because they had to wait at least an hour to be handed over to hospital staff, according to NHS ambulance service bosses. The health union Unison, which represents many ambulance staff, said the data showed that the ambulance service “is barely coping” with the huge number of calls it is receiving. A senior ambulance service official said the high volume of patients being put at risk because they had to wait outside A&E so long before receiving medical attention, and paramedics being prevented from answering other 999 calls, was “horrific” and “astronomical”. He added: “These figures also show that whatever NHS England say they are doing to try to resolve this huge problem, it clearly isn’t working.” Martin Flaherty, Association of Ambulance Chief Executives (AACE) managing director, said: “Our December 2022 data for handover delays at hospital emergency departments shows some of the worst figures we have recorded to date and clearly underlines that not enough is being done to reduce and eradicate these dangerous, unsafe and harmful occurrences.” Read full story Source: The Guardian, 25 January 2023 -
Content ArticleInadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project, published in Patient Safety, aims to improve hand-off communication from hospital to SNF by utilising a standardised hand-off tool. Authors conclude that the use of standardised hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardised hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.
