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Content ArticleA report has been published by Healthcare Inspectorate Wales (HIW) setting out the findings of a review of patient flow in Wales. Patient flow is the movement of patients through a healthcare system from the point of admission to the point of discharge. HIW specifically examined the journey of patients through the stroke pathway. This was to understand what is being done to mitigate any harm to those awaiting care, as well as to understand how the quality and safety of care is being maintained throughout the stroke pathway.
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Content ArticleThis is the first in a series of podcasts NHS England has produced to mark World Patient Safety Day 2023, and celebrate its theme of ‘engaging patients for patient safety’. The series features some of the Patient Safety Partners that work with the National Patient Safety Team, who play a vital role in providing a patient’s perspective to support our work to improve patient safety. In this podcast, Graham, who became a patient safety partner in 2020, shares his insights on the benefits of involving patients and why he feels it is so important in supporting the NHS to improve patient safety, and talks about his experience as a patient safety partner, particularly working to co-design elements of the medical examiner and medicines safety improvement programmes.
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Content ArticleThe nurse-to-patient ratio represents the number of patients a registered nurse cares for during a shift. Most hospitals have guidelines to ensure safe staffing ratios, but staffing shortages have led to heavier nursing workloads. This article outlines which US states have laws and regulations in place for safe staffing ratios.
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Content ArticleThe results of the latest annual survey of hospital inpatients published by the Care Quality Commission (CQC) show patient satisfaction levels have remained largely static since 2021, but indicate a longer term decline in most areas compared to previous years.People were eligible to take part in the survey if they stayed in hospital for at least one night during November 2022 and were aged 16 years or over at the time of their stay.The survey highlights growing frustration with waiting times and reveal that four in ten people scheduled for planned treatment said their health deteriorated while waiting to be admitted.An A-Z list of inpatient survey results by NHS trust can be found here.
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Content ArticlePatients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. The aim of this study was to identify a typology of responses that healthcare staff provide on Care Opinion, a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. The authors used framework analysis to qualitatively analyse a sample of 486 stories regarding hospital care and their 475 responses. Five response types were identified: non-responses, generic responses, appreciative responses, offline responses and transparent, conversational responses. The key factors that varied between these response types included the extent to which responses were specific and personal to the patient story, how much responders' embraced the transparent nature of public online discussion and whether or not responders suggested that the feedback had led to learning or impacted subsequent care delivery. Staff provide varying responses to feedback from patients online, with the response types provided being likely to have strong organisational influences. The findings offer valuable insight and have both practical and theoretical implications for those looking to enable meaningful conversations between patients and staff to help inform improvement. The authors suggest that future research should focus on the relationship between response type, organisational culture and the ways in which feedback is used in practice.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. James talks to us about the value of patient feedback in boosting morale and enabling organisations to make real patient safety improvements. He also describes the power of the unique perspective patients have on safety, and asks how we can use this insight to shift culture and provide safer care. -
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A patient harmed by orthodontic treatment shares their story
Anonymous posted an article in Patient stories
In this anonymous blog, a patient shares their experience of orthodontic treatment which they undertook to reduce overcrowding of their teeth. However, instead of solving the problem, the treatment caused multiple, complex dental issues that have resulted in severe pain and a high financial cost. The patient talks about how their orthodontist has been unwilling to take any responsibility for the issues caused, threatening legal action if the patient pursues any claims against them. They also discuss the reluctance of other orthodontists to get involved in trying to treat the issues they now face, and call for regulators and governments to look into the issue of negligent orthodontic treatment.- Posted
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Content ArticleEven those at the top admit the NHS can’t do what is being asked of it today. But it is far from unsalvageable – we just need serious politicians who will commit to funding it, writes Gavin Francis, who shares his experience as a GP in this Guardian long read.
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Content ArticleThe aim of this study from Hutchinson et al. was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department.
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Content ArticleMany patients struggle to book a GP appointment in England. Once people have been successful in getting a booking to see their doctor, however, how long are they having to wait for their appointment? Charlotte Paddison looks at the latest data to reveal the answer – and argues that quick access to GP appointments is not the only factor to consider.
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The patient's chair: a blog by Dr Faisal Saeed
Fsaeed posted an article in Patient-centred care
In this blog, Dr Faisal Saeed talks about the patient-provider power imbalance using an AI generated image of two chairs to illustrate his points.- Posted
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A patient's tales of woe
Clive Flashman posted an article in By patients and public
This blog tells the story of a patient, a relation of Patient Safety Learning's Chief Digital Officer. It explains how the patient was failed by the system, seemingly a system designed to fail when its users need it most. Some of the issues described here are technology-based in nature, but the concepts are easy to grasp. A phrase that another person commented when hearing about this story was "when common sense and compassion are lost, there is no hope left for the NHS". I think we have now entered that territory (sadly). Do feel free to comment or add your own stories below....- Posted
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Content ArticleSuccessful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
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As reported recently, the Scottish Healthcare Workers Coalition called upon the Scottish Government to reinstate 'universal masking' in health and social care settings. In this statement written in support of their campaign, an occupational safety and health practitioner, David Osborn, explains the legal requirements for risk assessments that the Government ought to have undertaken before reaching such a decision that exposes healthcare staff to the life-changing consequences associated with repeat Covid-19 infections. He also explains the legal duty of the Government to consult with workers before implementing changes that may affect their health and safety. Neither duty (risk assessment nor prior consultation with workers) appears to have been well met, putting the Scottish Government and Health Boards in breach of UK-wide health and safety law. -
Content ArticleWhole-body bathing or showering with a skin antiseptic to prevent surgical site infections (SSI) is a usual practice before surgery in settings where it is affordable. The aim is to make the skin as clean as possible by removing transient flora and some resident flora. Several organisations have issued recommendations regarding preoperative bathing. The care bundles proposed by the United Kingdom (UK) High impact intervention initiative and Health Protection Scotland recommend bathing with soap prior to surgery. The Royal College of Surgeons of Ireland recommends bathing on the day of surgery or before the procedure with soap . The USA Institute of Healthcare Improvement bundle for hip and knee arthroplasty recommends preoperative bathing with CHG soap. Finally, the UK-based National Institute for Health and Care Excellence (NICE) guidelines recommend bathing to reduce the microbial load, but not necessarily SSI. In addition, NICE states that the use of antiseptics is inconclusive in preventing SSI and that soap should be used. The purpose of this systematic review is to assess the effectiveness of preoperative bathing or showering with antiseptic compared to plain soap and to determine if these agents should be recommended for surgical patients to prevent SSI.
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Community PostHello everyone, We know there is much learning to be gained from listening to patient and families. This is particularly true when it comes to patient safety. Have you had an experience that you'd like to share with us? Maybe you identified a risk or shared a concern and were listened to and unsafe care was avoided? Maybe you weren't listenied to or you didn't realise what was going on and you or your family member were harmed? How did you find out about the patient safety incident? Was information shared with you that you needed to know? Were you supported? Was there an invetsigation into the incident and were you invited to contributed to it? Were lessona learned and acted upon? Have others learned from this experience, do you know?
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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 Article
The Family Oops and Burns First Aid eBook
Kristina Stiles posted an article in Recommended books and literature
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'The Family Oops and Burns First Aid' is a free children's book written by Kristina Stiles, beautifully illustrated by Jill Latter, created to support children and their families learning about burns prevention and first aid principles together. The book describes an accident prone family who are not burns aware, who have to go to school to learn about burn safety and first aid principles within the home. The book is aimed at KS1 children and their families, and is available as hard copy book by request from Children's Burns Trust and also as an audio/video book via YouTube. -
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AHRQ: Team STEPPS
Patient Safety Learning posted an article in How to engage for patient safety
AHRQ's TeamSTEPPS - Team Strategies and Tools to Enhance Performance and Patient Safety - is an evidence-based set of teamwork tools, aimed at optimising patient outcomes by improving communication and teamwork skills among healthcare teams, including patients and family caregivers. -
Content ArticleHow can we ensure that health and care staff from all backgrounds feel respected, valued and listened to at work? Siva Anandaciva sits down with Karen Bonner, Chief Nurse at Buckinghamshire Healthcare NHS Trust, to talk about the value of having a diverse workforce, and how we can make the health and care system fairer for staff, patients, and communities from ethnic minority groups.
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Content ArticleSafety netting is a consultation technique to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient’s condition. It is a way of managing clinical risk and helping patients identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health. Former GP Professor Paul Silverston discusses the purpose of safety-netting and offers advice on a structured approach to implementing it in practice. Further reading on safety netting: Safety-netting in general practice: how to manage uncertain diagnoses Optimising GPs’ communication of advice to facilitate patients’ self-care and prompt follow-up when the diagnosis is uncertain: a realist review of ‘safety-netting’ in primary care
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Content ArticleAs a doctor, receiving a letter from the GMC confirming that a complaint has been raised against you by a patient, and the GMC are now investigating that complaint, can be a frightening experience. This blog by solicitor Nicola Wheater, looks at how communication failings can lead to GMC complaints and describes what to expect from the process. She also highlights support available for doctors facing a GMC complaint.
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Content ArticleIn this guide you’ll read real complaints made against GPs when a patient’s expectations differ from their experience. The Medical Defence Union has created this collection of case studies detailing in each case the complaint, the advice given and the outcomes, in order to demonstrate the support available to GPs in these extremely challenging situations. You will need to submit your details below to download the guide containing the case studies.
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Content ArticleThis opinion piece in the Journal of Eating Disorders looks at the use of the diagnosis 'terminal anorexia' and its impact on people with anorexia nervosa, their families and the healthcare professionals working with them. Alykhan Asaria offers a lived-experience perspective on how the term may cause distress and harm to patients, feeding the narrative power of an individual's eating disorder. The article also talks about how the term can remove hope from patients, families and clinicians, and how it might set a dangerous precedent in paving the way for people with other mental health conditions to be labelled 'terminal'.
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“I’ve been mocked, scolded and gaslighted”: a harmed patient’s experience of orthodontic treatment
Anonymous posted an article in Other conditions and diseases
In this opinion piece, a patient shares their experience of trying to access support from the healthcare system for debilitating jaw pain. They describe being dismissed and laughed at by doctors and orthodontists, highlight a knowledge gap around jaw issues and outline the need for more accountability in the orthodontics industry.
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