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Showing results for tags 'Emergency medicine'.
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Content ArticleUS doctor Frederick Gibson describes his experience having a sudden cardiac arrest as a 26 year-old medical student. It took paramedics 45 minutes to resuscitate him in his kitchen and two further rounds of CPR before he reached the hospital to keep him alive. Frederick describes the profound impact the experience has had on him and his partner and reflects on how it has changed his attitude to the experience of being a patient. He highlights the significance of interactions between doctors and their patients—a doctor's words, tone and attitude are carried by the patient in their everyday life, outside of the consultation room, for the next few months and years.
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Content ArticleIn this opinion piece for The Guardian, Adrian Chiles describes how his father was unnecessarily transferred from a community hospital to an A&E department by a locum GP. This caused his father—who was largely alone, confused and without his hearing aids—great distress, and should have been avoided, as healthcare professionals said the transfer had been unnecessary. Adrian describes his father's rapid deterioration following the incident and his regret that some of his father's last days were spent—avoidably—in distress. He says, "The process, the system, the protocols, the whatever, take hold and the wrong thing happens even though everyone can see it’s wrong but is powerless to put a stop to it."
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Content ArticleOver three months, a Dispatches reporter has filmed secretly while working in a major NHS A&E department. The undercover footage exposes the suffering and dangers patients face on a daily basis.
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News Article
NHS in summer crisis of emergency care waits, doctors say
Patient Safety Learning posted a news article in News
The NHS is engulfed in a summer crisis, senior doctors have said, amid severe ambulance delays, corridors crowded with trolleys and patients facing 25-hour waits in A&E units. The Royal College of Emergency Medicine (RCEM) sounded the alarm over the “national scandal” of long waits for emergency care that it said were leading to “entirely preventable” deaths at a time of the year when there should be some respite from the traditional pressure experienced over winter. Elderly people in particular were facing the brunt of the impact, with many forced to endure horrific long waits for a bed once a decision had been taken to admit them to hospital, the college said. A snapshot survey by the RCEM of emergency department chiefs from across the UK, conducted between Monday and Wednesday this week, exposed the extent of the summer crisis in hospitals. Nine in 10 (91%) of 63 A&E bosses admitted NHS patients were “coming into harm” on their wards due to the quality of care that could be delivered under current conditions. Eighty-seven per cent said they had patients being treated in corridors and 68% said they had patients waiting in ambulances outside their A&E. One emergency department leader revealed that one of their patients this week waited more than 19 hours for a hospital bed to become available once a decision was made to admit them after they had already waited six hours to be seen. Overall, the patient ended up waiting 25 hours in A&E. Read full story Source: The Guardian, 20 June 2024 Related reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift Reflections on a clinical shift: "After 20 years of nursing, this is one of the worst shifts I have ever completed" -
Content ArticleSafety risks exist in all medical care settings, but emergency medicine professionals face particular challenges as they strive to deliver the safest, highest quality care to their patients. Massachusetts emergency departments rank high in a national review of ED quality and safety. Yet many frontline staff express concerns that the environment is not as safe as it needs to be for patients or staff. In response to these concerns from their members, leaders of the Massachusetts College of Emergency Physicians (MACEP) reached out to the Betsy Lehman Center to help facilitate work to improve safety in emergency departments across the state. The Massachusetts Emergency Nurses Association (MENA) and the Massachusetts Association of Physician Assistants (MAPA) joined as partners in the effort. Through this collaboration, the Betsy Lehman Center convened an expert panel to identify key risks to safety in emergency departments, recommend practical steps for mitigating these risks, and develop a toolkit to support implementation of the recommendations. Recognising the broad range of safety issues facing emergency medicine clinicians and staff, the expert panel focused on interventions that could be executed from “within the four walls” of the emergency department in three key areas: (1) crowding; (2) cognitive overload; and (3) care coordination.
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Content ArticleMaternal morbidity and mortality is rising in the United States. Previous studies focus on patient attributes, and most of the national data are based on research performed at urban tertiary care centers. Although it is well understood that nurses affect patient outcomes, there is scant evidence to understand the nurse work system, and no studies have specifically studied rural nurses. The authors of this paper, published in The Joint Commission Journal on Quality and Patient Safety, sought to understand the systems-level factors affecting rural obstetric nurses when their patients experience clinical deterioration.
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News ArticlePatients with cancer and those needing emergency operations were among those who had their treatment cancelled this week due to a major cyberattack on NHS hospitals in London. More than 200 emergency and life-saving operations, including those which should be done within 24 hours, had to be cancelled by Guy’s and St Thomas’ Foundation Trust (GSTT) and King’s College University Hospital NHS Foundation Trust. It is not yet clear how long the disruption will last, however hospitals are concerned they will struggle if it continues for more than a few days. According to a source, Synnovis carries out tens of thousands of tests a day but is unable to do so as it cannot access systems. The Independent revealed: More than a third of procedures and operations have been cancelled, which includes over 3,000 non-surgical appointments and hundreds of patients who have been referred for urgent cancer diagnosis. Mothers waiting to have c-sections have also had their procedures cancelled and hospitals are investigating potential harm. Transplant operations have been cancelled and hospitals have had to reduce the number of people they’re able to book in. Read full story Source: The Independent, 10 June 2024
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Content ArticleEvidence shows that nurse staffing affects patient safety events (PSEs), but the role of an appropriate nursing care delivery system remains unclear. This Japanese study aimed to investigate whether nursing care delivery systems could prevent PSEs. The findings suggest that in an emergency intensive care unit, a collaborative nursing care delivery system was associated with a decrease in PSEs.
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Content ArticleThe National Academies of Sciences, Engineering, and Medicine (NASEM) report Improving Diagnosis in Health Care calls for healthcare professionals to engage patients in diagnostic decision making. Patient engagement refers to the concept of patients being actively involved in their healthcare, including but not limited to engaging with medical providers and the health system in diagnosis, treatment, and overall disease management decisions. The emergency department (ED) presents unique challenges to engage patients in the diagnostic process. Patients evaluated in the ED typically have no prior relationship with the care team. Engagement is further challenged in the unpredictable, chaotic environment where clinicians operate in time-constrained situations and care for multiple patients simultaneously. Finally, patients presenting to the ED may be critically ill, emotionally distressed, intoxicated, or otherwise unable to fully participate in their own care. Health information technology (IT) is increasingly used to promote patient engagement by enhancing patient-provider communication, ensuring shared decision making, and enabling positive behavioural changes. Health IT tools such as electronic patient portals, mobile text messaging, health apps, and recent advancements in virtual environments offer new opportunities for patient engagement in the ED. This Agency for Healthcare Research and Quality (AHRQ) brief reviews the current state of health IT-based methods for engaging patients in the diagnostic process in the ED and outlines opportunities for further development.
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News Article
More NHS hospitals leaving patients in corridors to free up ambulances
Patient-Safety-Learning posted a news article in News
More and more UK hospitals are leaving patients in corridors due to a lack of bed space. NHS bosses say so-called corridor care is freeing up ambulances and saving lives, but BBC Newsnight has spoken to patients who say the growing practice is humiliating and degrading. Gregory Knowles counted 13 other patients alongside him on a corridor at the Norfolk and Norwich University Hospital (NNUH) in March. Complications after an operation put him back in hospital and on to a ward but at 04:00 one morning he was moved. The 68-year-old was wheeled in his bed to reception. "I was waking up with people around me. It was horrendous," he told the BBC. "I had no screens and no facilities for water or for really getting changed. My possessions were on the bottom of the bed. My daughter and partner were as horrified as I was," he said. His partner Alicia Goulty described how staff had been too rushed to attend to him. "One day when we got there his catheter had leaked in the bed when he was on the corridor. He was wet with no covers or any screens and I had to take him to the bathroom to get him cleaned". Ms Goulty said her partner's medication had been missed. "We had to ask for water for him. We had to ask sometimes for his meals because he got forgotten." Read full story Source: BBC News, 15 May 2024 You can read a nurse's first-hand account of a corridor care shift in this blog on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift -
Content ArticleIn this article, published by Pragmatic Improvement, Pete Gordon discusses the 2023 NHS staff satisfaction survey and the link with emergency department performance.
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News ArticlePatients needing urgent treatment for life-threatening illness such as strokes or heart attacks waited more than 24 hours for an ambulance response, new figures show. New data shows the crisis facing NHS ambulance services resulted in every region missing vital NHS targets to respond to some of the most critically unwell patients last year. Despite improvements compared to 2022, figures obtained by the Liberal Democrat party show ambulance services continued to struggle with response times to category two patients, which may include those who have suffered a stroke or heart attack and should receive a response within 18 minutes. In two cases patients needing this level of response, in Warrington and Staffordshire, waited more than 25 hours for an ambulance. Sir Julian Hartley, chief executive at NHS Providers, which represents all NHS trusts, called for “urgent” investment and warned that “rising demand, limited resources and vast staff shortages are piling pressure on an already-stretched service, further driving up ambulance waiting times.” He said NHS hospital and ambulance leaders are working to reduce delays and responses at a time “when demand has never been higher.” Read full story Source: The Independent, 23 April 2024
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Content ArticleThis French cohort study in JAMA Internal Medicine aimed to find out whether spending a night in the emergency department (ED) associated with increased in-hospital mortality and morbidity among older patients. The results showed that older patients who spent a night in the ED showed a higher in-hospital mortality rate and increased risk of adverse events compared with patients admitted to a ward before midnight. This finding was particularly notable among patients with limited autonomy.
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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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Content ArticleNHS England’s response to claims of excess deaths due to long A&E waits leaves a lot to be desired, writes Steve Black for the HSJ. The Royal College of Emergency Medicine (RCEM) claim that more than 250 A&E patients are dying each week because they waited more than 12 hours to be admitted. If long waits in A&E are killing an extra 250-400 people every week, it is the biggest performance problem in the NHS. NHSE should urgently ask their analysts to rework this analysis with current data to test (or refute) the validity of the claim. The first step to solving a huge problem is admitting the scale of the problem, not denying it exists. This analysis features a refinement of the RCEM estimate that includes estimated mortality from waits between four and 12 hours. This increases the estimate to 400 extra deaths per week compared to the RCEM number of 250.
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Content Article
Panorama investigates a private hospital chain being used to help clear the NHS waiting list. With more than six million people in England alone waiting for an operation on the NHS, Monika Plaha investigates the safety record of one of the UK's biggest private healthcare providers. -
Content ArticleRead the Royal College of Emergency Medicine's general election manifesto. A one page summary is below and the full manifesto can be found at the link at the bottom of the page.
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Content ArticlePrime Minister Rishi Sunak promised speedier care, but specialists believe long waits for hospital beds are costing thousands of lives. The pledge he made in January last year, as one of five priorities on which he said voters should judge him, was that “NHS waiting lists will fall and people will get the care they need more quickly”. New calculations by the Royal College of Emergency Medicine (RCEM) show that, with regard to the broader aim of delivering speedier treatment, his government is falling shockingly short.
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News Article
Long A&E wait times lead to more than 250 needless deaths a week
Patient Safety Learning posted a news article in News
More than 250 patients a week could be dying unnecessarily, due to long waits in A&E in England, according to analysis of NHS data. The Royal College of Emergency Medicine analysed the 1.5 million who waited 12 hours or more to be admitted in 2023. A previous data study had calculated the level of risk of people dying after long waits to start treatment and found it got worse after five hours. The government says the number seen within a four-hour target is improving. This is despite February seeing the highest number of attendances to A&E on record, it adds. The Royal College of Emergency Medicine (RCEM) carried out a similar analysis in 2022, which at that time resulted in an estimate of 300-500 excess deaths - more deaths than would be expected - each week. The analysis uses a statistical model based on a large study of more than five million NHS patients that was published in 2021. RCEM president Dr Adrian Boyle said long waits were continuing to put patients at risk of serious harm. "In 2023, more than 1.5 million patients waited 12 hours or more in major emergency departments, with 65% of those awaiting admission," he said. "Lack of hospital capacity means that patients are staying in longer than necessary and continue to be cared for by emergency department staff, often in clinically inappropriate areas such as corridors or ambulances. "The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm." Read full story Source: BBC News, 1 April 2024 -
Content ArticleThe idea of Emergency care services experiencing seasonal spikes in demand – so called ‘Winter Pressures’ are fast becoming a thing of the past. Instead, long waits have become the new norm year-round, and staff are caring for patients in unsafe conditions on a daily basis. It is well established that long waits are associated with patient harm and excess deaths. Last year the UK Government published a Delivery Plan for the Recovery of Urgent and Emergency Care (UEC) services. A year on, far too many patients are still coming to avoidable harm. New analysis by the Royal College of Emergency Medicine (RCEM) reveals that there were almost 300 deaths a week associated with long A&E waits in 2023.
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Content ArticleWith a record number of patients stuck in A&E, Healthwatch England’s CEO Louise Ansari wants to see a longer-term plan to improve conditions in which people wait for life-saving care. This should include real-life monitoring and reporting on patient experience.
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EventJoin Emergency Services Times to delve deep into fostering a culture of that encourages speaking up in emergency services, shedding light on effective strategies and leaving outdated approaches behind. Reports into culture may grab headlines but underneath, it is about behaviour and creating a working environment and channels that allow staff to have a voice, speak up and report without fear of reprisal. Through the lens of Crimestoppers and the National Guardian's Office, we look at what works and how to move on from approaches that simply don't serve the needs of those working within the emergency services sector. Register
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Content ArticleThis report, produced in collaboration with the Association of Ambulance Chief Executives and the NHS Confederation, highlights the pivotal role ambulance trusts play in delivering urgent and emergency care and sets out a long-term vision for an enhanced role they could take in co-designing this care. It sets out the case for change and includes several case studies that demonstrate the benefits of ambulance services taking this broader approach.
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Content ArticleDiagnostic delays in the emergency department (ED) are a serious patient safety concern. This retrospective cohort study included children treated at 954 EDs across 8 states, and examined the association between ED volume and delayed diagnosis of first-time diagnosis of an acute, serious conditions (e.g., bacterial meningitis, compartment syndrome, stroke). The researchers found that EDs with lower pediatric volume had higher rates of delayed diagnosis across 23 serious conditions.
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Content ArticleCentral venous catheters (CVCs) are widely used in US critical care settings for medication administration, monitoring and reliable venous access. Despite the benefits of CVCs, complications, particularly infections, have become a major focus of US hospital quality improvement efforts due to federal and state initiatives that emphasise patient safety, transparency and accountability. In this commentary in JAMA Network, the authors look at recent research surrounding CVC complications and highlight approaches to help tackle these issues.
