scholarly journals Developing the COVID-19 intensive care medical equipment distribution platform: outcomes and lessons learned

2021 ◽  
Vol 10 (2) ◽  
pp. e001383
Author(s):  
Emmanuel Adeoluwa Akinluyi ◽  
David Stell ◽  
Nayanee Perera ◽  
Christopher Sibley-Allen
Keyword(s):  
Intensive Care ◽  
Medical Equipment ◽  
Early Stage ◽  
Lessons Learned ◽  
System Capacity ◽  
Full Potential ◽  
Implementation Approach ◽  
Innovation Projects ◽  
The Uk ◽  
Clinical Engineers

During the first wave of the coronavirus pandemic, the UK government took the decision to centralise the procurement, allocation and distribution of mission-critical intensive care unit (ICU) medical equipment. Establishing new supply chains in the context of global shortages presented significant challenges. This report describes the development of an innovative platform developed rapidly and voluntarily by clinical engineers, to mobilise the UK’s shared medical equipment inventory, in order to match ICU capacity to dynamically evolving clinical demand. The ‘Coronavirus ICU Medical Equipment Distribution’ platform was developed to optimise ICU equipment allocation, distribution, collection, redeployment and traceability across the National Health Service. Although feedback on the platform has largely been very positive, the platform was built for a scenario that did not fully materialise in the UK and this affected the implementation approach. As such, it was not used to its full potential. Nonetheless, the platform and the insights derived and disseminated in its development have been extremely valuable. It provides a prototype for not only optimising system capacity in future pandemic scenarios but also a means for maximally exploiting the large amount of new equipment in the UK health system, as a result of the coronavirus pandemic. This early stage innovation has demonstrated that a system-wide pooled information resource can benefit the operations of individual organisations. It has also generated numerous lessons to be borne in mind in innovation projects.

scholarly journals COVID-19: additive manufacturing response in the UK

2020 ◽  
Vol 4 (3) ◽  
pp. 167-174
Author(s):  
Elen J Parry ◽  
Craig E Banks
Keyword(s):  
Additive Manufacturing ◽  
Severe Acute Respiratory Syndrome ◽  
Medical Equipment ◽  
Lessons Learned ◽  
Protective Equipment ◽  
Safety Regulations ◽  
Novel Coronavirus ◽  
The Uk ◽  
Am Processes ◽  
Regulatory Landscape

Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, caused global disruption specifically in linear supply chains. Increased demand for already disrupted services led to a global shortage of medical equipment and personal protective equipment. Use of additive manufacturing (AM) processes by the manufacturing community has shown great innovation, agility and flexibility to fill supply chain gaps and meet shortfalls. In the context of contingency reaction to a global healthcare emergency, decisions have had to be made quickly, in some cases bypassing device safety regulations. This concentrated and spontaneous use of AM has highlighted the challenges and risks of such innovation, which we discuss in relation to the UK’s current regulatory landscape. We have discussed lessons learned and the potential future impact upon wider use of AM in healthcare.

Best Value and Performance Management Inspired Change within UK Councils

2014 ◽  
pp. 199-226
Author(s):  
Sandra Moffett ◽  
Tim Walker ◽  
Rodney McAdam
Keyword(s):  
Knowledge Management ◽  
Public Sector ◽  
Performance Management ◽  
Exploratory Study ◽  
Lessons Learned ◽  
Full Potential ◽  
Best Value ◽  
And Performance ◽  
The Uk

This chapter focuses on an exploratory study from an operational perspective, investigating the role of Knowledge Management (KM) in the UK Public Sector, the case setting being within the council’s waste services. Key literary findings outline that while Government seeks to improve council service delivery, significant legacies remain from earlier change programmes that appeared to be restricting the Local Government Modernisation Agenda (LGMA). Given the exploratory nature of the study, a theory building approach is adopted based on results from the exploratory study. The findings show that although knowledge and information flows could inform performance management frameworks to trigger change, a lack of suitable networks or a culture of knowledge sharing, combined with tight implementation timescales and a shifting agenda, meant that councils did not respond as anticipated due to systemic weaknesses. As with many organisations, KM implementation did not reach full potential. However, there are a number of lessons learned and key findings that can act as a learning process for further knowledge management applications within public sector contexts.

scholarly journals Critical care transfers and COVID-19: Managing capacity challenges through critical care networks

2020 ◽  
pp. 175114372098027
Author(s):  
Eleanor Pett ◽  
Hai Lin Leung ◽  
Emily Taylor ◽  
Martin Shao Foong Chong ◽  
Teddy Tun Win Hla ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Strategic Alliance ◽  
Healthcare Providers ◽  
Lessons Learned ◽  
Policy Makers ◽  
North West ◽  
Individual Unit ◽  
The Uk

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients. Within a short 50-day period 223 patients were transferred within the network to distribute pressures. This unprecedented number of critical care transfers, combined with the creation of extra capacity and new pathways, allowed the region to continue to offer timely and unrationed access to critical care for all patients who would benefit from admission. This extraordinary response is a testament to the power and benefits of a regionally networked approach to critical care, and the lessons learned may benefit other healthcare providers, managers and policy makers, especially in regions currently facing new outbreaks of COVID-19.

scholarly journals Critical Care Transfers and COVID-19: Managing Capacity Challenges through Critical Care Networks

2020 ◽  
Author(s):  
Eleanor Pett ◽  
Hai Lin Leung ◽  
Emily Taylor ◽  
Martin Shao Foong Chong ◽  
Teddy Tun Win Hla ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Strategic Alliance ◽  
Healthcare Providers ◽  
Lessons Learned ◽  
Policy Makers ◽  
North West ◽  
Individual Unit ◽  
The Uk

The intensive care units in North West London are part of one of the oldest critical carenetworks in the UK, forming a mature and established strategic alliance to shareresources, experience and knowledge for the benefit of its patients. North WestLondon saw an early surge in COVID-19 admissions, which urgently threatened thecapacity of some of its intensive care units even before the UK government announcedlockdown. The pre-existing relationships and culture within the network allowed itsmembers to unite and work rapidly to develop agile and innovative solutions, protectingany individual unit from becoming overwhelmed, and ultimately protecting its patients.Within a short 50-day period 223 patients were transferred within the network todistribute pressures. This unprecedented number of critical care transfers, combinedwith the creation of extra capacity and new pathways, allowed the region to continue tooffer timely and unrationed access to critical care for all patients who would benefitfrom admission. This extraordinary response is a testament to the power and benefitsof a regionally networked approach to critical care, and the lessons learned maybenefit other healthcare providers, managers and policy makers, especially in regionscurrently facing new outbreaks of COVID-19.

Institutional developments, standards and river quality: a UK history and some lessons for industrialising countries

1996 ◽  
Vol 33 (3) ◽  
pp. 211-222 ◽  
Author(s):  
D. W. M. Johnstone ◽  
N. J. Horan
Keyword(s):  
Middle Ages ◽  
Aquatic Environment ◽  
Industrial Revolution ◽  
Integrated Management ◽  
Sewage Treatment ◽  
Lessons Learned ◽  
Process Manufacturing ◽  
Treatment And Disposal ◽  
The Uk ◽  
Developed World

From the middle ages until the early part of the nineteenth century the streets of European cities were foul with excrement and filth to the extent that aristocrats often held a clove-studded orange to their nostrils in order to tolerate the atmosphere. The introduction in about 1800 of water-carriage systems of sewage disposal merely transferred the filth from the streets to the rivers. The problem was intensified in Britain by the coming of the Industrial Revolution and establishment of factories on the banks of the rivers where water was freely available for power, process manufacturing and the disposal of effluents. As a consequence the quality of most rivers deteriorated to the extent that they were unable to support fish life and in many cases were little more than open sewers. This was followed by a period of slow recovery, such that today most of these rivers have been cleaned with many having good fish stocks and some even supporting salmon. This recovery has not been easy nor has it been cheap. It has been based on the application of good engineering supported by the passing and enforcement of necessary legislation and the development of suitable institutional capacity to finance, design, construct, maintain and operate the required sewerage and sewage treatment systems. Such institutional and technical systems not only include the disposal of domestic sewage but also provisions for the treatment and disposal of industrial wastewaters and for the integrated management of river systems. Over the years a number of institutional arrangements and models have been tried, some successful other less so. Although there is no universally applicable approach to improving the aquatic environment, many of the experiences encountered by the so-called developed world can be learned by developing nations currently attempting to rectify their own aquatic pollution problems. Some of these lessons have already been discussed by the authors including some dangers of copying standards from the developed world. The objective of this paper is to trace the steps taken over many years in the UK to develop methods and systems to protect and preserve the aquatic environment and from the lessons learned to highlight what is considered to be an appropriate and sustainable approach for industrialising nations. Such an approach involves setting of realistic and attainable standards, providing appropriate and affordable treatment to meet these standards, establishment of the necessary regulatory framework to ensure enforcement of the standards and provision of the necessary financial capabilities to guarantee successful and continued operation of treatment facilities.

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

2021 ◽  
pp. 147775092110366
Author(s):  
Harika Avula ◽  
Mariana Dittborn ◽  
Joe Brierley
Keyword(s):  
Intensive Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
General Setting ◽  
Daily Practice ◽  
Paediatric Intensive Care ◽  
Ethical Challenges ◽  
Legal Cases ◽  
Ethics Support ◽  
The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

ICU admissions: Consequences after discharge

2020 ◽  
Vol 13 (9) ◽  
pp. 550-556
Author(s):  
Minal Karavadra ◽  
Ricky Bell
Keyword(s):  
Intensive Care ◽  
Cognitive Decline ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Psychiatric Disturbance ◽  
Intensive Care Department ◽  
Previous Level ◽  
The Uk

The intensive care department may seem a long way from the GP's consulting room, but every year tens of thousands of critically ill patients are admitted to intensive care units (ICUs) across the UK. Patients are often left with long term sequelae that may require GP input. Physical weakness, psychiatric disturbance and cognitive decline are not uncommon after an illness that requires a stay in an ICU. These hinder a patient’s return to their previous level of function and impact caregivers after discharge. This article aims to highlight the chronic symptoms patients can acquire during ICU admission that may come to the attention of GPs for their advice and treatment.

scholarly journals AGILE: a seamless phase I/IIa platform for the rapid evaluation of candidates for COVID-19 treatment: an update to the structured summary of a study protocol for a randomised platform trial letter

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gareth O. Griffiths ◽  
Richard FitzGerald ◽  
Thomas Jaki ◽  
Andrea Corkhill ◽  
Helen Reynolds ◽  
...  
Keyword(s):  
Phase I ◽  
Early Stage ◽  
Late Phase ◽  
Optimum Dose ◽  
Open Label ◽  
Link Type ◽  
Hospitalised Patients ◽  
Volunteer Study ◽  
The Uk ◽  
Phase Trial

Abstract Background There is an urgent unmet clinical need for the identification of novel therapeutics for the treatment of COVID-19. A number of COVID-19 late phase trial platforms have been developed to investigate (often repurposed) drugs both in the UK and globally (e.g. RECOVERY led by the University of Oxford and SOLIDARITY led by WHO). There is a pressing need to investigate novel candidates within early phase trial platforms, from which promising candidates can feed into established later phase platforms. AGILE grew from a UK-wide collaboration to undertake early stage clinical evaluation of candidates for SARS-CoV-2 infection to accelerate national and global healthcare interventions. Methods/design AGILE is a seamless phase I/IIa platform study to establish the optimum dose, determine the activity and safety of each candidate and recommend whether it should be evaluated further. Each candidate is evaluated in its own trial, either as an open label single arm healthy volunteer study or in patients, randomising between candidate and control usually in a 2:1 allocation in favour of the candidate. Each dose is assessed sequentially for safety usually in cohorts of 6 patients. Once a phase II dose has been identified, efficacy is assessed by seamlessly expanding into a larger cohort. AGILE is completely flexible in that the core design in the master protocol can be adapted for each candidate based on prior knowledge of the candidate (i.e. population, primary endpoint and sample size can be amended). This information is detailed in each candidate specific trial protocol of the master protocol. Discussion Few approved treatments for COVID-19 are available such as dexamethasone, remdesivir and tocilizumab in hospitalised patients. The AGILE platform aims to rapidly identify new efficacious and safe treatments to help end the current global COVID-19 pandemic. We currently have three candidate specific trials within this platform study that are open to recruitment. Trial registration EudraCT Number: 2020-001860-27 14 March 2020 ClinicalTrials.gov Identifier: NCT04746183 19 February 2021 ISRCTN reference: 27106947

scholarly journals Why Protect Ancient Woodland in the UK? Rethinking the Ecosystem Approach

2020 ◽  
pp. 1-24
Author(s):  
Jona Razzaque ◽  
Claire Lester
Keyword(s):  
High Speed ◽  
Biodiversity Loss ◽  
Ecosystem Approach ◽  
Lessons Learned ◽  
Value Systems ◽  
Ancient Woodland ◽  
Forestry Practices ◽  
Regulatory Frameworks ◽  
Trade Offs ◽  
The Uk

Abstract Sites of ancient woodland in the United Kingdom (UK) are diminishing rapidly and the multifunctional forest management system with its fragmented approach fails effectively to protect such woodland. In the face of reports on the destruction of ancient woodland, the HS2 High-Speed train project in the UK signifies the extent of trade-offs among the key stakeholders. Such large infrastructure projects typically come with high environmental and social costs, including deforestation, habitat fragmentation, biodiversity loss, and social disruption. This article examines the protection of ancient woodland in the UK and assesses the challenges in applying the ecosystem approach, an internationally recognized sustainability strategy, in the context of such protection. A better understanding of the ecosystem approach to manage ancient woodland is critical for promoting sustainable forestry practices in the UK and informs the discussion in this article of the importance of conserving ancient woodland globally. Lessons learned from UK woodland policies and certification schemes include the need to have in place strong regulatory frameworks, introduce clear indicators, and recognize pluralistic value systems alongside economic considerations. The article concludes that the protection of ancient woodland in the UK requires distinct and strong laws that reflect multiple values of this resource, acknowledge the trade-offs among stakeholders, and adopt an inclusive approach to reduce power asymmetries.

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