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Posts Tagged ‘Patient safety’

Putting the blame game in perspective

By Katherine Teale - 29th August 2010 12:55 pm

I was walking down the corridor today when I almost bumped into one of my colleagues. When I say “bumped into” I mean he nearly knocked me down the stairs in his effort to pretend I don’t exist.

The three people with me were greeted with cheerful ‘hellos’, but I have evidently committed a crime for which I must be soundly ignored. I’ve no idea what this offence is - perhaps he holds me, as clinical director, personally responsible for the hospital’s economic doldrums.

Whatever it is he’s kept this up for six months now without accidentally letting slip even a hint of a smile when we pass one another in theatre, so you have to admire his reflexes and persistence. It must be quite an effort to be so consistent about this - I doubt whether I could remember whom I’m not saying ‘hello’ to quite so successfully. Perhaps he keeps a list written on the back of his hand.

Talking about blame, there’s been lots of it around this week. The internet is full of the shocking story of the two year old who had a plaster of Paris cast applied to the wrong arm. This wasn’t noticed by anyone until the following day when mum was so traumatised that she had to go straight to the press.

This report is followed by the inevitable seven pages of public vitriol, the gist of which is that doctors and nurses are an overpaid, underworked bunch of idiots who can’t even tell right from left and should be sacked. Or worse. The fact that the nurse involved had tried to calm the distressed toddler by putting a cast on her teddy bear first only seemed to fan the flames of public outrage, as apparently they had managed to treat the correct arm on the teddy, but sadly not on the child.

Anyone who has tried to treat a distressed, screaming two-year-old will understand that it wouldn’t be immediately obvious which was the arm with the greenstick fracture. Presumably all the angry citizens expressing disbelief that the NHS can be so crap have A. never made a mistake, and B. never heard of ‘human error’.

I suppose it’s just more fun to post, while frothing at the mouth, about how some incompetent junior doctor, who might even have been foreign, took three attempts to put a drip up when you were in casualty. Of course, what the hospital in question needs to do, after publishing a grovelling apology, is institute a checklist system in A&E whenever a procedure like that is performed, even when the patient is awake.

We’re already doing this in theatres using the WHO check list which has been mandated by the National Patient Safety Agency. It’s entirely about avoiding human error - children can’t tell you when you’re doing the wrong thing, and even wide awake adult patients will allow nerve blocks, for instance, to be performed on the wrong side, without a word of protest.

Despite what we might think from the internet message boards, most patients assume we know what we’re doing. Whether they’re always justified in doing so is another question.

Tags: Patient safety
Posted in Katherine Teale | 1 Comment »

Weekend emergencies are more likely to die

By Mike Broad - 22nd June 2010 9:20 am

People admitted to English hospitals in an emergency at the weekend have a greater chance of dying than those admitted during the week, a study finds.

The study, in Quality & Safety in Health Care, analysed the deaths of patients admitted as emergencies to 163 acute hospital trusts in England during 2005/06. It reveals a 7% higher mortality rate for emergency admissions over the weekend. It was particularly evident in conditions like heart attack, heart failure, stroke, some cancers and aortic aneurysms.

The study’s authors say the higher than expected mortality rates may be linked to less consistent specialist services, such as diagnostics, at weekends and a decrease in the availability of senior hospital staff.

In the study, by researchers from Imperial College London and Dr Foster Intelligence, the researchers reviewed 215,054 deaths out of a total of 4,317,866 admissions.

Comparing the expected number of deaths with the actual number of deaths identified at the weekend the researchers found there were 3,369 more deaths than expected at the weekend in 2005/06.

Author Dr Paul Aylin said: “We need to get to the bottom of what this means. Staffing levels are often lower at weekends, with fewer senior medical staff around, and some specialist services are less available. We believe this may be contributing to the increase in mortality rates on Saturdays and Sundays but we would like to see more research.

“Hospitals have been reassessing the working hours and rotas of their doctors and, considering the impact that staff availability may be having on mortality rates, this is a timely reminder to hospitals that they must take care not to jeopardise the quality and standard of patient care available at weekends when devising new staffing rotas.”

These findings follow the Temple review into training under the Working Time Regulations which found that the NHS was “too reliant” on junior doctors who are often left to work unsupervised on wards overnight and at weekends.

The report also criticised the working hours of consultants who often prefer to work a standard week which inevitably impacts on patient treatment and junior staff training.

Tags: Patient safety
Posted in Hospital Dr News | 4 Comments »

Surgery targets endanger patient safety, poll reveals

BBC Health - 17th June 2010 10:01 am

Pressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.

About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.

The government says “a culture of micromanagement” has endangered safety.

A total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.

Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.

Interrupted doctors provide poorer care

By Mike Broad - 17th May 2010 12:40 pm

Hospital doctors who are frequently interrupted while working in a clinical environment spend less time on tasks and fail to return to almost a fifth of their jobs, research reveals.

The study finds that on average doctors were interrupted 6.6 times an hour and 11% of all tasks were interrupted.

These interruptions - such as a doctor being asked a question by a colleague while they were trying to write a prescription - meant that doctors, when they did return to the job in hand, tended to spend less time on it than if they had carried out the task with no pause.

For tasks with one interruption, doctors tended to complete the task in about half the time they would have spent if they had not been interrupted.

The authors speculate, in the journal Quality and Safety in Health Care, that one reason for the quicker completion of a task that had been interrupted was that doctors decided to work more quickly to compensate for the time spent dealing with the interruption.

However, in almost a fifth of cases (18.5%), doctors failed to return to the task they had been working on before being interrupted.

Interruptions happened most often during documentation (around 43%) and direct and indirect care (17% and 19% respectively). Doctors were least likely to be interrupted when taking part in professional communication or social activities.

Many fear that repeated interruptions raise the likelihood of clinical errors being made.

The study, conducted in the emergency department of a 400-bed teaching hospital in Australia, shows that doctors multi-tasked for 12.8% of the time and the average time spent on a task was 1.26 minutes.

The authors conclude: “Our results support the hypothesis that the highly interruptive nature of busy clinical environments may have a negative effect on patient safety.

“Task shortening may occur because interrupted tasks are truncated to ‘catch up’ for lost time, which may have significant implications for patient safety.”

Read the full research.

Tags: Patient safety
Posted in Hospital Dr News | No Comments »

After 13 years of Labour, do we have a high performing NHS?

By Mike Broad - 13th April 2010 11:14 am

Opposition parties are painting a picture of an NHS with major deficiencies. The Labour government, however, believes that the NHS is ‘good’ but needs further transformation to become ‘great’.

The King’s Fund released a review this week, called A High Performing NHS, which assesses how far the investment and accompanying reforms since 1997 have transformed the NHS in England. The following is a summary of its findings:

1. Access

Since 1997, there have been major and sustained reductions in waiting times for most hospital treatments. Now most patients are seen, given tests and treated within 18 weeks of referral by their GP. More progress is needed in some specialties and services which are not included in the targets. Sustaining short waiting times might prove challenging as funds tighten in the future.

There have also been improvements in the number and variety of primary care services, and most people can access GP services within the target of 48 hours. Progress is needed in access to out-of-hours care. The government has identified public demand for some kinds of hospital care to be delivered closer to home, but progress in shifting care out of hospital settings has been slow.

2. Patient safety

Ongoing increases in the number of reported safety incidents reflect improved reporting and coding, but under-reporting continues to be a major obstacle, particularly in primary care, and will have to be addressed in the future.

There have also been considerable efforts made to learn from adverse events and disseminate that learning to the NHS front line. But it is clear that there is some way to go on creating a fully open culture of reporting within NHS organisations.

3. Health promotion

There has been significant progress in tackling smoking. It is too soon to see the benefits of the most radical legislative action - the 2007 ban on smoking in public places - but the effects are likely to accelerate falls in smoking rates and associated ill health.

This review has found that progress has been more elusive in reducing harm from alcohol and rates of obesity. Consumption of alcohol has increased since 1998, accompanied by a rise in alcohol-related hospital admissions and rates of liver disease, suggesting more aggressive, cross-departmental action will be needed in the future. The prevalence of obesity is rising in adults and children, despite government targets to halt the increase.

4. Clinically effective

This review considered the progress made in relation to the three major health conditions which account for the most NHS spending: cancer, cardiovascular disease and mental ill health. Mortality from cancer and cardiovascular disease has fallen substantially since 1997 and suicides have also reduced.

Even though mortality and survival rates for several cancers have been improving they still lag behind those of other European countries and effort will need to be sustained in the areas already identified as needing further work, for example, early diagnosis and access to radiotherapy.

There have been notable improvements in access to cardiac surgery and recommended standards of stroke care, and these have contributed to falling mortality for cardiovascular disease. However, variations in quality persist.

In mental health services, access to specialist early intervention and crisis resolution teams for acute illness has improved and is judged to be one of the best systems in Europe. This has led to reductions in acute admissions, but long-term reductions in symptoms and improvements in the quality of life of service users have been more difficult to achieve.

5. Patient experience

Overall public satisfaction with the way the NHS is run has been increasing steadily for the past few years.

Understanding how patients experience the NHS has been transformed through the creation of one of Europe’s largest patient experience surveys. Most patients report being treated with dignity and respect but progress still needs to be made in relation to choice, involving patients with their care and some aspects of the hospital environment.

6. Equity

From 1997 there was a clear shift in government policy towards reducing inequalities in health outcomes, and goals were put in place to reflect this ambition. Infant mortality has reduced and life expectancy has improved for all social groups in England; however, progress has been faster among less deprived groups. Targets to reduce gaps in infant mortality and life expectancy between the most deprived areas and the national average have not been met.

Questions remain about the extent to which reducing inequalities has received adequate investment and commitment from the NHS.

New legal requirements on the NHS to ensure equitable access for all patients regardless of age, gender, disability, ethnicity, religion and sexual orientation, as well as deprivation, represent a big challenge in the future.

7. Efficiency

NHS productivity overall has declined over the last decade despite the introduction of stronger incentives through new hospital payment systems and quasi-market reforms in part designed to bear down on production costs.

Higher pay costs have absorbed more than half of the increase in the financial resources that became available to the NHS since 2002. On the other hand, substantial savings have been made in the cost of medicines and other goods and services used.

There is substantial scope for further savings through more efficient delivery of hospital and other services, such as reducing lengths of stay in hospitals, increasing the rate of day case surgery, and using lower-cost drugs.

8. Accountability

Since 1997, accountability of NHS trusts to the government has been strengthened, particularly through the use of targets and strong direct performance management.

NHS trusts are also accountable to local commissioners, but it is clear that PCTs are still at a fairly early stage of development in their capacity to use commissioning as a lever, in part due to several years of reorganisation.

There have been significant developments in creating more locally accountable services, for example, through the creation of foundation trusts with members and elected governors. The impact of these changes has so far been limited.

One of the government’s most striking contributions in this area has been to set up independent regulators of health care organisations to inspect and assure the quality of services.

Professional regulation has also been overhauled, with the aim of making the professions more responsive to public rather than professional interests, but many of the changes are still very recent.

There has also been effort to make the system more accountable to individuals, notably through the NHS constitution.

Summary

In summary, the King’s Fund says the NHS is closer to being a high-performing health system now than it was in 1997. It is capable of delivering high-quality care to some patients, in some areas, some of the time.

But, it claims work remains to be done to fill in the gaps: unwarranted variations in access, utilisation and quality of care even where national guidelines exist; ensuring that patients’ experiences have a real impact on the quality of care locally; and, above all, ensuring there is adequate investment and energy in tackling the preventable causes of ill health and better support and care for those living with chronic conditions.

Read the full report.

Tags: Election, Patient safety, Prevention
Posted in Features | No Comments »

NHS hospitals ignore patient safety orders

The Guardian - 16th February 2010 10:03 am

Hospitals were accused of putting patients’ lives at unnecessary risk after research revealed they were failing to comply with NHS orders designed to prevent deaths from mistakes involving drugs, surgery or equipment.

Information released by the Department of Health after a freedom of information request showed that hospitals were not complying with safety alerts issued by the National Patient Safety Agency (NPSA).

The NPSA’s chairman, Lord Patel of Dunkeld, said that the behaviour of the trusts was unacceptable and endangered the health of patients.

“It’s not good enough,” he said. “What’s the point of us developing these alerts if they don’t pay any attention to them? Alerts are produced to reduce risk and hopefully avoid many deaths, so not to implement them to me is alarming. If they aren’t implemented then they run the risk of harm occurring and the danger will continue.”

The findings were from a FOI request submitted by patient safety charity Action Against Medical Accidents (AvMA). It revealed that:

• 104 hospitals and other providers of NHS care in England have not confirmed they have implemented an NPSA alert issued in March 2007 to ensure that injectable medicines are used more safely - even though new systems are meant to be in place by March 2010. The alert came after 25 patients died and 28 others experienced serious harm in 18 months.

• 81 hospitals and other care providers had not taken the “required actions” outlined in patient safety alerts covering opioid (painkilling) medicines. The alert was originally issued in July 2008 with a deadline of January 2009; the 81 had not complied by 29 December 2009.

Andy Burnham defends NHS targets after failings

HSJ - 2nd December 2009 5:53 pm

The health secretary has defended the government’s targets for the NHS in the wake of failings at several hospitals.

Andy Burnham told the Commons the best hospitals were providing “high quality, safe care” as well as meeting performance targets, such as seeing accident and emergency patients within four hours.

He was responding to criticisms from the Tories that clinical priorities were being “distorted” by targets, with waiting times put above patient care.

Burnham said patient safety was his “highest priority” as he made a statement to MPs following revelations about high death rates at Colchester Hospital University Foundation Trust and poor hygiene and standards of care at Basildon and Thurrock University Hospitals Foundation Trust.

A report by Dr Foster Intelligence rated a dozen hospitals as “significantly underperforming”, despite nine of them being rated good or excellent by official regulator the Care Quality Commission.

Seven hospitals were also found to have considerably higher mortality rates for the past five years.

Surgeons say quality of care worse with WTD

By Mike Broad - 11th October 2009 9:28 pm

Patients are more at risk since the European Working Time Directive was introduced in August, a survey of surgeons reveals.

The research, by the Royal College of Surgeons, shows that 64% of surgeons thought quality of care had worsened due to the 48-hour week.

A third say handover arrangements are inadequate in their hospital and 23% say they cannot stay involved in all stages of individual patients clinical care that require their expertise. With so many shift changeovers, the WTD has compromised the time available for handovers and damaged continuity of care.

Furthermore, 62% of surgeons said they were not working a truly compliant 48-hour week with 70% estimating they worked more than 48 hours, averaging between 55 and 60 hours a week.

Trainee surgeons in particular are staying on unpaid after the hours limit because they want to see through care for patients. Some are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week.

A quarter of respondents say other professionals in the healthcare team are acting up to cover tasks previously done by surgeons and 43% say they are covering rota gaps in other areas of their own hospital to keep services running.

The Royal College of Surgeons says hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result, there is an emerging ‘grey’ market in hospital cover with doctors true working hours being kept off the books.

The college has also learned that more than 100 further hospital rotas have applied for a ‘derogation’ from the government because they cannot meet the legislation.

The government set an original deadline of 28 May for trusts to request the derogation, which is a two-year delay to WTD implementation during which time juniors can work a 52-hour week. It claims all but 200 rotas are compliant.

Mr John Black, president of the Royal College of Surgeons, said: “Throughout this affair the call from the Department of Health has been that this legislation is about making patients safer. We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.

“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead-end shifts as locums because there is no way the service could keep running otherwise.”

Earlier this year, surgical trainee organisations called for a 65-hour week and the college called for a sectoral opt-out of the European legislation to achieve this.

Nine hundred surgeons responded to the survey.

A spokesman for the DoH said there is no evidence of harm being caused to patients.

A recent survey by Remedy showed that 47% of juniors claimed their rotas were non-compliant.

Tags: Derogation, Patient safety, WTD
Posted in Hospital Dr News | No Comments »

Patient safety incidents in NHS increase by 12%

HSJ - 8th October 2009 11:15 am

The number of patients who have been involved in safety incidents while undergoing NHS treatment has risen by 12% in six months.

The National Patient Safety Agency released new figuresrevealing that 459,500 people were affected between 1 October 2008 and 31 March 2009 in England.

The data also showed that 5,700 patients experienced serious harm or died because of mistakes and near misses.

The NPSA said the rise was due to improved reporting. Overall, in 303,016 (66%) of the cases no harm came to the patient and in 122,246 (27%) there was low harm.

A further breakdown showed 28,521 (6%) of incidents ended in moderate harm and 5,717 (1%) resulted in severe harm or death.

Thirty two per cent of reports were accidents involving patients that could have been avoided, followed by errors or near misses with treatments or procedures (10.1%) and medication (9.4%).

Trusts to review safety of out-of-hours GP services

The Guardian - 2nd October 2009 9:53 am

All 152 NHS organisations responsible for out-of-hours GP services in England have been ordered to review patient safety following the case of a German doctor who accidentally killed a patient on his first shift in Britain.

PCTs, which commission emergency overnight and weekend care for millions of people, will receive letters today from the Department of Health telling them to re-examine induction and training for foreign doctors, call-handling and prioritising of cases, clinical decisions made by GPs and other staff and the management of powerful drugs.

The instruction reinforces a warning from the NHS watchdog the Care Quality Commission that shortcomings so far identified in its investigation of the incident may be repeated elsewhere.

Government officials and Steve Field, chairman of the Royal College of GPs, have been asked by ministers to consider whether further changes are needed nationally to the system under which local trusts check that doctors are fit to practise and speak and understand English.

The government response reflects concern within the NHS over the case in which Daniel Ubani killed David Gray at his home in Cambridgeshire by administering a tenfold overdose of a painkiller. There are fears that Gray’s death highlights systemic failures.