Trusts told to create ‘dedicated A&E space’ for mental health patients

Every emergency department in London has been advised to create “dedicated space” to care for three mental health patients, due to concerns over long waiting times for people in crisis. To access HSJ click here and ring the library 01905 760601 for access password

Mental health nurses and paramedics to respond together to reduce avoidable hospital admissions

Thousands of Londoners experiencing a mental health crisis will be sent a specialist nurse and a paramedic in a car on blue lights. Read NHS England news here

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

NHS Performance Statistics - January 2018

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

Exclusive: A&E doctors tell prime minister patients are dying in corridors

Clinical leads for emergency departments warn prime minister of premature deaths in corridors
A&E waiting time performance has dipped to between 45 per cent and 75 per cent at times
Doctors say winter preparations failed to deliver and call for significant funding boost

Senior doctors in charge of more than 60 hospital emergency departments have written to the prime minister warning of “very serious concerns” about patient safety amid the winter crisis, including a case of patients dying prematurely in corridors.

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Preventing emergency hospital admissions for children and young people

A briefing from Nuffield Trust looks at the relationship between deprivation and the use of emergency hospital care by children and young people in England.

It describes areas of inequality and explores how they have changed over time. As well as looking at the overall patterns of emergency hospital use, it focuses in particular on three common conditions – asthma, diabetes and epilepsy – where more timely and effective primary, community or outpatient care could prevent admissions.

NHS to consider routine use of ‘drunk tanks’ to ease pressure on A&Es

NHS England Chief Executive Simon Stevens has announced that the NHS will decide this year whether “drunk tanks” should routinely be used take pressure off hard-pressed A&E departments and 999 ambulance services during the seasonal holiday period.

Supervised areas where revellers who have over-indulged can be checked and even sleep it off if necessary, rather than being taken to casualty, are already used in some areas such as Newcastle, Bristol, Manchester and Cardiff.

NHS to consider routine use of ‘drunk tanks’ to ease pressure on A&Es

NHS England Chief Executive Simon Stevens today announced that the NHS will decide this year whether “drunk tanks” should routinely be used take pressure off hard-pressed A&E departments and 999 ambulance services during the seasonal holiday period. Click here to see NHS England post

A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project

BMC Emergency Medicine 201717:40 https://doi.org/10.1186/s12873-017-0149-y

Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.

UHCW Research: Charles E. Hutchinson

Admissions of inequality: emergency hospital use for children and young people

Does a child's socioeconomic background have an effect on rates of admissions to hospital for common conditions such as asthma, diabetes or epilepsy?  Report from the Nuffield Trust.

A service evaluation of surgical tracheostomies in the emergency theatre at University Hospital, Coventry: time for a dedicated tracheostomy team?

British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e96 

The routine practice of surgical tracheostomy has been challenged by bedside percutaneous dilatational tracheostomy (PDT). Whilst PDT is cost-effective and time-efficient, there is still a place for the open technique in patients with unfavourable anatomy, unstable cervical spine injuries and/or coagulopathies. Complication rates of the open technique are often lower, but booking such cases into busy emergency theatres may prove difficult.

UHCW Research: Miesha Virdi, Priya Chohan, Ross Elledge, Roger Townsend and Gary Walton

Summary of published key strategic guidance for health Emergency Preparedness, Resilience & Response (EPRR)

The charts shown in this NHS England document give an overview of the key strategic EPRR guidance documents currently published. For published documents, website links are embedded in the charts.

Planning for seasonal demand in respiratory illness

Each winter, emergency departments experience a surge in respiratory attendances and emergency admissions for respiratory conditions double. It is therefore crucial to plan for this inevitable increase in demand so that patient flow is maintained.

A “quick guide” from NHS Improvement highlights ways to manage demand, including ambulatory emergency care, early supported discharge services, and urgent “hot” clinics. Use of these initiatives can reduce avoidable overnight admissions and improve patient flow and outcomes.

Local A&E delivery boards are advised to consider the recommendations as part of plans to manage the seasonal surge in respiratory admissions.

NHS performance statistics - December 2017

Combined Performance Summary

• Urgent and emergency care – Accident and Emergency, NHS111, Ambulances, Delayed Transfers of Care 
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care, Patient Reported Outcome Measures 
• Cancer - Cancer Waiting Times, Cancer Registrations, Cancer Emergency Presentations, Cancer Survival Estimates 
• Mental Health - Early Intervention in Psychosis, Out of Area Placements, Children and Young People with an Eating Disorder, Contacts and Referrals, Improving Access to Psychological Therapies

New analysis shows impact of redesigning urgent and emergency care in Northumberland

The Health Foundation has published analysis examining the early impact of changes to A&E and urgent care services in Northumberland following the opening of the country’s first bespoke emergency hospital in Cramlington in 2015.

Out in the cold: lung disease, the hidden driver of NHS winter pressure

This report from the British Lung Foundation identifies a seasonal trend in respiratory admissions over the last seven years and argues that a failure to address this annual fluctuation is contributing to winter A&E pressures. It argues that community care and support outside of hospital needs to be strengthened and that service planning for a rise in respiratory admissions is needed to manage this seasonal variation.

An uncommon approach: four organisations selected to replicate health and social care interventions

Four organisations have each been awarded £145,000 by the Health Foundation to replicate successful health and care interventions using social franchising and licensing techniques. Social franchising and licensing are methods to replicate and scale interventions that have not yet been used widely in health care in the UK.

The projects are:

Scaling and replicating IRIS through social franchising

Lead organisation: IRISi

IRIS is a successful general practice-based training, support and referral programme that improves the identification and support offered to people with experience of domestic violence and abuse (DVA). One in four women and one in six men will experience DVA during their lifetime, with DVA against women being more frequent and more severe, with long-lasting effects that also have an impact on children. IRIS will be replicated through social franchising so that the programme can be implemented more widely, and more people can be supported. IRISi, a social enterprise set up to house the programme, will support other sites to engage commissioners, and recruit and train staff.

Replicating Pathway’s homeless health hospital team model to towns and cities experiencing significant homelessness

Lead organisation: Pathway

Homeless patients attend emergency departments four times more often than the general population, are admitted eight times more often and stay three times as long. Ten hospitals have implemented Pathway’s integrated care model ensuring that homeless patients admitted to hospital have access to the health care they need and support to recover. Pathway will use social franchising or licensing to replicate the model in places with significant homeless populations that would benefit from adopting it.

Scale up, replication and licensing of the PINCER intervention

Lead organisation: The University of Nottingham

In a recent study, prescribing errors were identified in 5% of prescription items, with one in 550 items containing a severe (potentially life threatening) error. This equates to around 1.8 million serious prescribing errors in English general practices each year. PINCER is a successful pharmacist-led information technology intervention for reducing common medication errors in general practice prescribing, and has been incorporated into national guidelines to support medicines optimisation. PINCER will be replicated in GP surgeries across the country; helping them to protect patients at risk of errors, and reduce medication-related hospital admissions and deaths.

Developing a licensed, social franchising model for regional hubs to roll out effective local multi-professional maternity training

Lead organisation: PROMPT Maternity Foundation

The PRactical Obstetric Multi-Professional Training (PROMPT) programme has been associated with a significant reduction in the number of babies with a low oxygen level at birth and also babies born with a permanent nerve injury following difficulties with their shoulders. Through social franchising and using a regional hub system, it is hoped that this improved implementation model will ensure that PROMPT training may be associated with the same improvements in outcomes across the country.

The new projects are currently subject to contracts being finalised.

The effect of non-steroidal anti-inflammatory drugs on severity of acute pancreatitis and pancreatic necrosis

RCS Annals: https://doi.org/10.1308/rcsann.2017.0205

Acute pancreatitis (AP) is a common emergency presentation and can be disabling. There is significant morbidity and mortality associated with AP, and it places a considerable burden on the healthcare system. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have a protective effect in some elective contexts. This retrospective study aimed to evaluate the effect of NSAIDs on the course of AP and the severity of the disease.

UHCW Research: G Marangoni

Sharing best practice from clinical leaders in urgent and emergency care

The CQC has worked with senior clinical, nursing and managerial leaders from emergency departments at 17 hospital trusts across the country to develop a best practice resource for all NHS acute trusts.

Do nice guys finish last?

Emerg Med J. 2017 Dec;34(12):A879-A880. doi: 10.1136/emermed-2017-207308.30.

Emergency medicine is widely recognised as an intense specialty. Interruptions are known to derail thoughts, increasing cognitive load and result in longer periods before deep thought is re-established. Although approachability and warmth are regarded as important factors in clinicians we wondered what impact these characteristics had on the number of interruptions.

UHCW Research: Turner C and Turner J