Critical Incident Stood Down: Thursday 29 December

December 24, 2022

1.Critical incident stood down

This morning we took the decision to stand down our critical incident status.

Thank you to colleagues who worked tirelessly to provide the best care possible under challenging circumstances over the last 24 hours.

Your efforts to support the safe discharge of patients and quick ambulance handovers mean we are now in a much-improved position, however we are on EMS Level 4 which means we are still managing extreme pressure.

Our command and control structures remain in place as they have been over the last few years. If you have any questions or concerns please raise these directly with your managers or tactical leads.

Please continue to support the range of actions listed below that are focussed on helping us to continue to safely manage the flow of patients within our hospitals and prevent us from having to instigate a critical incident.

2. Supporting patients with timely discharges

We need to work together to effectively balance risk and safety by means of continually reviewing the daily discharges. This requires your support and recognising a change of practice in these extreme times. Our ask of you is to weigh up the pros and cons of our patients remaining in hospital and including patients and families in these discussions with a clear focus on what matters to them.

When planning discharges please ensure you work closely with colleagues in pharmacy to ensure the TTOs are prepared in good time.

Colleagues in the Integrated Discharge Hub are also available to support you. Call them on extension 3147 or via  integrated.discharge-hub@nhs.net (open 8am – 8pm, 7 days per week).

Remember the discharge lounges are now open 7 days a week from 7am through to 7pm at Sandwell and City Hospital:

• Sandwell – Newton 1
• City – now on D28 (moved from AMU 1)

The lounges are the ideal location for patients who no longer meet the criteria to reside in our acute bedbase. Patients can be stepped down to the lounge whilst awaiting TTOs, transport or transfer to MFFD beds.

Please include the discharge lounge in your patient discharge discussions so they are aware of the journey.

Note: Where it is safe to do so, you may be requested to take an extra patient in your ward area.

3. Alternatives to emergency departments

As we continue to be busy across our emergency care services, so it’s important that patients are aware of the alternative ways to seek medical help.

This can be done by calling into their local pharmacy, dialling NHS 111, contacting their GP, or going to an urgent care centre.

We operate an Urgent Treatment Centre at Sandwell Hospital and patients at City are able to attend the Urgent Care Centre at Heath Street, in Birmingham. Most GP practices are also offering weekend access.

We would urge you to share this information with family and friends. Click here to see more

4. Influenza is on the rise – Understand the risk and protect yourself, your family and your patients

We are seeing a huge rise in the numbers of patients admitted to our hospitals with influenza, a highly contagious respiratory illness that can cause severe illness and even death, especially in vulnerable populations such as the elderly and those with underlying health conditions. As healthcare professionals, it is important to protect ourselves, our families, and our patients from the risks of influenza.

One of the best ways to prevent the spread of influenza is to get vaccinated. The flu vaccine is effective in reducing the risk of contracting and spreading the virus, and it is especially important for healthcare workers to be vaccinated to protect ourselves and those we care for.

In addition to getting vaccinated, there are other simple steps we can take to protect ourselves and our patients from the flu. These include washing our hands frequently, covering our mouths and noses when sneezing or coughing, and staying home if we are feeling sick.

If you have any questions about the flu or how to protect yourself and your patients, please visit the following link for frequently asked questions: Influenza frequently asked questions

5. Staff isolation and when to return to work

The guidance for isolation and when to return to work for colleagues who have contracted COVID-19 has been revised.

Day 1 of isolation is the day after the colleague has developed symptoms, or if asymptomatic the date the positive LFT/PCR test was taken, whichever is earlier.

Colleagues can return to work from day 6 if they have had two negative lateral flow tests, feel clinically well and have a normal temperature. The LFTs should be taken 24 hours apart. The first LFT should not be taken before the day 4 and should ideally be taken as soon as possible on waking.

Further details on the isolation guidance can be found on Connect.

Inpatient screening for COVID-19 has also been updated. Positive COVID patients should be swabbed daily using LFT from day 4. If they have two consecutive negative results and no temperature, they can be stepped down from isolation.

Patients who are positive for flu can be stepped down from isolation on day 5 if they are asymptomatic. In rare occasions they can be stepped down on day 4 but this should only be done in agreement with the ward manager/clinical lead.  

Inpatient screening for COVID-19 has also been updated and can be found on the following link: Inpatient screening guide.

6. Are you aware of norovirus and other winter illnesses?

Norovirus, also called the “winter vomiting bug”, is a stomach bug that causes vomiting and diarrhoea. It can be very unpleasant, but usually goes away in about 2 days.

The main symptoms of norovirus start suddenly within 1 to 2 days of being infected, which includes:

• Feeling sick (nausea)
• Diarrhoea
• Being sick (vomiting)

You may also have:

• A high temperature
• A headache
• Aching arms and legs

You can usually treat yourself or your child at home. The most important thing is to rest and have lots of fluids to avoid dehydration. You will usually start to feel better in 2 to 3 days. Find out how to treat diarrhoea and vomiting in children and adults.

Please stay at home until you have not been sick or had diarrhoea for at least 2 days, as this is when you’re most infectious. Do not visit hospitals or care homes during this time.

Norovirus can spread very easily, and you can catch it from:

• Close contact with someone with norovirus
• Touching surfaces or objects that have the virus on them, then touching your mouth
• Eating food that’s been prepared or handled by someone with norovirus

Practicing good hand hygiene is important – washing your hands frequently with soap and water is the best way to stop it spreading. Alcohol hand gels do not kill norovirus.

Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or contact NHS 111 if you’re concerned about severe symptoms or need advice

7. Are you regularly washing your hands?

Regular hand washing with soap and water remains an essential part of good hygiene and helps prevent the spread of COVID-19, as well as other winter illnesses such as colds, flu and stomach bugs.

Your hands are the main pathway of germ transmission. Hand hygiene is therefore one of the most important measures to avoid the transmission of coronavirus. It is important to wash your hands thoroughly and more often, for at least 20 seconds each time with water and soap or hand gel.

Colleagues are advised to follow the 5 moments of hand washing:

1. Before touching a patient
2. Before clean/aseptic procedures
3. After body fluid exposure/risk
4. After touching a patient
5. After touching patient surroundings.

Watch this short video to remind yourself of the how to effectively wash your hands

8. Face mask fit testing – understanding your responsibilities

As part of our preparation for winter the face mask fit testing team are reminding colleagues of their responsibilities to ensure they have well-fitting and effective masks:

• All colleagues should be face mask fit tested to at least 2 types of mask. This can include a re-usable silicone mask.
• For each type of mask that is worn, face mask fit testing should be repeated every two years.
• All re-usable silicone masks must receive an annual check, to ensure that it is still fit for purpose.
• Filters for re-usable silicone masks must be changed every three months.
• All powered air purifying respirators (PAPR) must receive an annual check to ensure that is still fit for purpose and have their filters changed every three months.

Re-usable silicone masks and powered air purifying respirators can be handed into the old security bungalow at City site for maintenance, and then collected by the end of the day.

Fit testing can be booked via ESR. Colleagues who do not have access should call 07815020836 or 07815020808.

Any queries please email scott.shenton@nhs.net or call 07866007539.

9. Return to mask wearing in all clinical areas with immediate effect

The decision has been taken to reintroduce mask wearing in all clinical areas of the Trust.

Clinical areas include:

• All inpatient wards – acute and community
• All outpatient areas
• A&E
• Theatres
• Imaging departments
• Maternity
• Home visits
• All clinical buildings including at main entrances and public areas

The decision has been taken as a result of increasing cases of COVID-19 and flu affecting colleagues.