Mid Staffs Investigation
The report entitled Investigation into Mid Staffordshire NHS Foundation Trust (pdf) comes to over 150 pages. Dr Grumble has not read it all yet but he decided to do a search for the word 'target'. Unsurprisingly it appears over 50 times. Dr Grumble thinks that the management of this hospital focussed on the things that would make the management appear good and lost touch with the real purpose of a hospital which is to look after patients safely and effectively.
As happens in many hospitals clinicians were pressurised. Here is an example:
The junior doctors...........were often put under pressure to make decisions quickly in order to avoid breaches of the target......Dr Grumble has witnessed junior doctors being pressurised. It is so endemic that the pressure continues even when Dr Grumble is present. There is no insight into the fact that hassling a junior doctor into making a decision when he is not ready to do so is plain dangerous. Does this sort of thing happen in your hospital?
.......patients were sometimes rushed from A&E to the EAU without proper assessment and diagnosis.........[to meet the target]
4 comments:
the management of this hospital focussed on the things that would make the management appear good ...
...As happens in many hospitals clinicians were pressurised.
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Management trying to "appear good" is a result of pressure from the DoH Dr G. Clinicians are then pressurised in turn.
It is a horrendous problem caused by the DoH target culture. Trust management really don't have much choice.
Having said that, if target pressures are putting patients at risk, they should have the ethics and backbone to tell the DoH where to stick it...
But we know what the response to that would be don't we.
"There is no insight into the fact that hassling a junior doctor into making a decision when he is not ready to do so is plain dangerous. Does this sort of thing happen in your hospital?"
Yes this does happen in my hospital. Regularly. On a daily basis (unless there's plenty of beds. Which never happens.)
I once saw a manager with a clipboard arguing with a young, timid junior doctor (patient was at 3hrs 40mins). Junior doctor (surgical) wanted a medical opinion before possible discharge. Manager was not happy. Elderly man, 80's, acute confusion/abdo pain. RELATIVES HIGHLY CONCERNED RE CONFUSION = OUT OF CHARACTER. No surgical concerns...patient needing medical review.
Manager wants patient to be discharged due to 4 HOUR TARGET.
Manager argues with junior doctor in middle of department. Does not understand why someone who is "a bit confused needs to be seen by another doctor"
NO YOU DON'T UNDERSTAND...SO GO AWAY!
Poor junior doctor had to really fight her corner. Pt was seen by medics and diagnosed early sepsis. Admitted to ward at 5hours 20 minutes (we'll be fined for that failure). The doctor had the support of us A&E nurses..who intervened and backed her up. Good job that:
A) Doctor stood her ground
B) Nurses there to offer support
C) Relatives so insistent
Otherwise..patient would have been discharged home at 3 hours 55 minutes...home to deteriorate and probably die...BUT...at least we would have met our target...
The news piece shown alongside this post could lead the general public to believe that doctors and nurses were responsible fully, for the failings in care.
These statements are taken from the Healthcare Commission Report:
...The investigation found that there were not enough nurses at the hospital properly to care for emergency patients. A review of staffing levels in A&E in 2007/08 found the trust was short 120 nurses, of which 17 were needed in A&E, 30 were needed in the surgical division and 77 on the medical wards.
...The investigation also found that in 2006/07 the trust set itself a target of saving £10 million. To achieve this, over 150 posts were lost, including nurses. This was in a trust that already had comparatively low levels of staff.
..This led to - one qualified nurse to every 15 patients.
...The recommendations of the Society of Acute Medicine is = staffing ratio of one qualified nurse to every 6 patients.
...There is considerable evidence linking the number of
nurses to standards of care, particularly for
emergency admissions.
..Between the years 2005 and 2008, there was a reduction in beds as well as in nurses. There were 101 fewer beds and 297 fewer nurses
...In A&E doctors were often put under pressure to make decisions
quickly in order to avoid breaches of the 4 hour waiting target.
..Doctors were also diverted away from seriously ill patients in order to treat minor ones who were in danger of breaching the target.
..For the same reason, patients were sometimes rushed from A&E to
the EAU without proper assessment and diagnosis, or they were moved to the ‘assess and treat’ area, even though staff were not formally allocated to the area and patients were not properly monitored there.
...clinical decision units (CDUs) which staff said were used as "dumping grounds" to avoid breaching the four hour target for being treated in A&E
...Many of these issues required consideration and resolution at a strategic level, but were rarely
considered by the board or by its governance and risk sub-committees. ...more concerned with hitting targets, gaining Foundation Trust status and marketing and had 'lost sight' of its responsibilities for patient care.
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