New Quality standard [QS166] Trauma

New Quality standard [QS166] Trauma
Published date: March 2018  Next review: August 2018


This quality standard covers assessing and managing trauma (complex fractures, non-complex fractures, major trauma and spinal injury) in adults, young people and children. It describes high-quality care in priority areas for improvement.
For full guidance https://www.nice.org.uk/guidance/qs166

Emergency and acute medical care in over 16s: service delivery and organisation [NG94]

New: Guidance


This guideline covers organising and delivering emergency and acute medical care for people aged over 16 in the community and in hospital. It aims to reduce the need for hospital admissions by giving advanced training to paramedics and providing community alternatives to hospital care. It also promotes good-quality care in hospital and joint working between health and social services.


https://www.nice.org.uk/guidance/ng94

NIHR Signal Statins are of no benefit in acute respiratory distress syndrome

NIHR Signal Statins are of no benefit in acute respiratory distress syndrome


Giving statins to patients with acute respiratory distress syndrome made no difference to the number of days they spent on a ventilator. It also had no effect on mortality or the length of time spent in intensive care or in hospital compared with placebo.
Published on 13 March 2018
Read full document at https://discover.dc.nihr.ac.uk/portal/article/4000971/statins-are-of-no-benefit-in-acute-respiratory-distress-syndrome

NIHR Signal Hypertonic saline as effective as normal saline for trauma patients

NIHR Signal Hypertonic saline as effective as normal saline for trauma patients


Solutions more concentrated than normal, such as hypertonic saline, are as good as those more usually given to trauma patients with severe blood loss. Survival to hospital discharge was the same in patients treated before arrival at the hospital with either type of fluid.
Published on 13 March 2018
Read full document at https://discover.dc.nihr.ac.uk/portal/article/4000968/hypertonic-saline-as-effective-as-normal-saline-for-trauma-patients

NIHR Signal Hospital admission rates and costs increase in line with BMI

NIHR Signal Hospital admission rates and costs increase in line with BMI


Each 2kg/m² rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group. 


Published on 20 March 2018 
Full document available at: https://discover.dc.nihr.ac.uk/portal/article/4000975/hospital-admission-rates-and-costs-increase-in-line-with-bmi

Five safe, sustainable and productive staffing improvement resources

NHS Improvement has published five safe, sustainable and productive staffing improvement resources in the areas of maternity services, adult inpatients in acute care, district nursing services, learning disability services and mental health.

NIHR Signal Study raises questions about NHS “weekend effect”

The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness.

Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data.

Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate within 30 days was slightly higher for these admissions, it is likely that this was due to more severe illness. There was no difference in mortality for people who attended A&E but were not admitted.
NHS Trusts have been told by NHS England to reorganise services in line with “seven day working” to eliminate the weekend effect. These studies raise doubts as to whether such a reorganisation will achieve a reduction in mortality overall.

From the NIHR Dissemination Centre

No hospital is an island: Acute Care collaborations demonstrate new ways of working

A new report on lessons learnt from the acute care collaborations includes case studies highlighting how vanguards are finding new ways to:

· Standardise clinical practice, pooling expertise, sharing vital patient information and analysing patient care across hospitals.

· Make better use of clinical support services, such as imaging and pathology.

· More creatively and flexibly use the skills of their healthcare professionals, reducing reliance on agency staff.

· Build innovative external partnerships with, for example, the pharmaceutical industry.

· Support more integrated health systems that champion person-centred care.

· Consolidate corporate support functions to generate efficiencies.

The report is available in full here https://www.england.nhs.uk/publication/no-hospital-is-an-island-learning-from-the-acute-care-collaboratives/ 

Daily Insight: Cancelling at Christmas

New year’s resolutions

NHS England has told under pressure hospitals they can cancel non-urgent elective procedures to free up beds for patients coming through accident and emergency.


In a letter to trusts on Thursday afternoon, medical director Sir Bruce Keogh and national director for urgent and emergency care Dame Pauline Philip said the “expectation is that non-urgent inpatient elective care should be deferred until mid-January to ensure beds and staff are available for the sickest patients. By acting early, trusts can avoid last minute cancellations that can be costly and inconvenient for patients.”


To obtain this article copy and paste the post into an email and send to libraryw@uhcw.nhs.uk

Study shows home-based service for acute lung patients frees NHS beds

An acute ‘hospital-at-home’ scheme for patients with lung disease could save the NHS millions if replicated nationally. A study of the multidisciplinary service, which includes physiotherapists, found that it had reduced hospital stays from an average of 9.1 days to 2.5 days, saving £1,400 per case and has proven to be as effective as purely hospital-based treatment when measured by the number of re-admissions.

Join enhanced care improvement collaborative for inpatient acute/community trusts

NHS Improvement is launching an enhanced care improvement collaborative in March 2018 to deliver an improved experience for critically ill or vulnerable patients in hospital. The programme will build on the learning from the pilot programme in 2015/16 and roll out best practice.

Transforming care: views sought on NHS quality checkers’ toolkits

NHS England is testing toolkits for quality checkers to use in the assessment of services for people with autism and/or learning disabilities including GPs, community services, dental, acute care, accident and emergency and mental health.

These draft toolkits have been co-produced with people with a learning disability, autism or both and include health issues that are important to them. Most of the toolkits have been tested in some NHS services, but NHS England wants to gain the views of people who work in the services, commissioners and others who are interested in this work. The closing date of 1 December 2017.

NIHR Signal Simple preventive actions by parents linked to fewer child injuries

Education is promoted as a way to tackle the scale of avoidable injuries to young children. Children have two to five times the risk of an accident leading to injury if a parent leaves them on a raised surface, places hot drinks within reach, or does not put medicines away straight after use.
For example, children are also more than twice as likely to attend hospital for falling on stairs if their parent leaves stair gates open or does not use them.


From the NIHR Dissemination Centre

Rehabilitation after critical illness in adults [QS158]

New NICE quality standard covers adults with rehabilitation needs as a result of critical illness that required level 2 or level 3 critical care. It describes high-quality care in priority areas for improvement.

Little-known facts about university hospitals

University hospitals play a crucial role in the NHS, delivering high-quality acute care, training the doctors and health professionals of tomorrow and conducting groundbreaking clinical research.

Despite a distinct role and purpose within the healthcare system, the breadth of their contribution is not always fully understood.

This infographic, developed with the Association of UK University Hospitals, sheds light on their significant contribution.

Asfotase alfa for treating paediatric-onset hypophosphatasia [HST6]

Asfotase alfa (Strensiq) is available on the NHS as a possible treatment for paediatric-onset hypophosphatasia for people

• who meet particular criteria for treatment (outlined in the 5‑year managed access arrangement) and 
• if they (or their parents or carers) agree to the conditions in this arrangement, such as attending clinics, data collection and assessment of how well the treatment is working. 
• If you are not eligible for asfotase alfa but are already taking it, you should be able to continue until you and your doctor decide when best to stop.

NICE will take the information about how well the treatment works into account when the guidance on asfotase alfa is reviewed. If NICE does not recommend asfotase alfa for NHS funding when a review of the guidance is published, it will no longer be available for any patient.

Emergency and acute medical care in over 16s: service delivery and organisation

NICE guideline: short version.  Draft for consultation,  It includes recommendations for the organisation and delivery of emergency and acute medical care. Recommendations are included on:

• first points of contact with emergency and acute care services
• alternatives to hospital care
• opening hours and locations of acute care services
• services within hospitals
• ward rounds, transfers and discharges
• monitoring and managing hospital bed capacity

Inspiring change: a review of the quality of care provided to patient receiving acute non-invasive ventilation

This NCEPOD report focuses on the quality of acute non-invasive ventilation clinical care, for patients aged 16 years or older who are admitted to hospital.  It takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and organisational care of these patients

Cumbria’s NHS joining forces to get patients up, dressed and moving

NHS Trusts in Cumbria have joined forces to raise awareness and help patients across acute and community hospitals to get up, get dressed and get moving.

The campaign, which is in already popular on social media, is aimed at enabling hospitalised patients to get up, dressed and moving in order to avoid the potential negative impact of being bed-bound while in hospital.

Barbara Pinguey, specialist physiotherapist at North Cumbria University Hospitals NHS Trust, said: “By getting up, dressed and moving, patients can speed up their recovery, get home sooner and maintain their normal routines."

Older People in Acute Care Improvement Programme

With the number of older people increasing in our population, the need to ensure that they receive appropriate care in our healthcare system also increases. The ‘Improving Care for Older People in Acute Care’ workstream is a two-year programme to improve the care for older people in acute care. This work complements the scrutiny programme currently taking place to identify strengths and areas for improvements across hospitals in NHS Scotland.