Recommendations issued to improve patient safety in acute medical units

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Digital healthcare and an increase in senior staff availability are just some of the recommendations made by experts following a ten-year patient safety analysis of acute medical units.

Researchers from Cardiff University and University College London carried out a ten-year analysis of patient safety incidents in hospital acute medical units across England and Wales, concluding that several changes need to be made to reduce the number of future incidents. Recommendations include the introduction of electronic prescribing and monitoring systems, checklists to reduce diagnostic errors, and an increased presence of overnight and weekend senior clinicians and pharmacists to reduce the vulnerability of less experienced staff.

The findings from the analysis, which is the first to cover all severe harm and death incident reports in acute medical units in England and Wales, have been published in the Journal of the Royal Society of Medicine.

Acute medical units were introduced in 2004 to relieve pressures on emergency departments and improve patient outcomes. However, little is known about patient safety incidents occurring within these units.

Diagnostic error most common incident

For the analysis, researchers looked at a total of 377 acute medical unit incidents, reported to the National Reporting and Learning System for England and Wales which led to severe harm or death between 2005 and 2015. The findings identified diagnostic error as the most common incident type, with delayed diagnosis the most common diagnostic error, and cancer the most frequently missed diagnosis.

Lead researcher Dr Andrew Carson-Stevens, Clinical Reader in Patient Safety and Quality Improvement at Cardiff University’s School of Medicine, and lead for patient safety research at PRIME Centre Wales, said: “The reports in this study came from frontline healthcare professionals over a ten-year period and our detailed analysis highlights where acute medical units can review their existing systems to ensure they are as safe as possible.

“The learning from these incident reports represents an invaluable opportunity to improve the safety of acute medical units for future patients. The NHS also stands to improve overall staff wellbeing by using the insights to design work environments that maximise their performance and mitigate risks, resulting in unsafe care outcomes in this often high-pressured care setting.”

A common theme observed throughout the incident reports was the dependence on individual people for patient advocacy to remind staff about investigations or referrals.

Dr Sarah Yardley, of University College London, said: “Patients who were unable to self-advocate due to their illness or other vulnerabilities were often overlooked due to system pressures and may be most at risk.”


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