Worcestershire

Noted (AI summary) NHS England acknowledges the coroner's concerns, notes that the BSG is updating guidance, and states they will support the implementation of any changes; they have shared the report with relevant NHS Trusts and ICBs and are monitoring reports nationally. NICE acknowledges the coroner's concerns and notes that the relevant CKS is being updated by Agilio Software; NICE will consider the issues raised through its guideline surveillance process. The BSG plans to issue a statement to members and publish a journal letter regarding management of patients with coronary stents on anticoagulants needing endoscopy, recommending switching to aspirin or discussing with interventional cardiology.

Noted (AI summary) NICE acknowledges the concerns and notes that its new guideline on adrenal insufficiency covers identification, emergency management, and prevention of adrenal crisis during physiological stress, including trauma. The guideline committee includes paramedic co-optees and other relevant health professionals. NHS England reports that the JRCALC guidelines will be amended to improve understanding of administering steroids in cases of trauma, and that a Regulation 28 Working Group discusses all PFD reports to identify emerging trends. WMAS highlighted existing JRCALC guidance updates regarding steroid usage for adrenal crisis (2017, 2020, 2022), communication to staff via clinical times briefings, and the introduction of steroid emergency cards. WMAS also apologized for an administrative error that led to the lead investigator not receiving the inquest disclosure bundle and stated that the legal team aims to attend as many inquests as possible. AACE is revising JRCALC guidance to emphasize steroid administration to patients suffering trauma or physiological stress, engaging with the Addison's Disease Self-Help Group and The Addison's Clinical Advisory Panel Chair. AACE is also aware of the development of an educational e-learning package for call handlers to improve understanding of Addison's disease and steroid-dependent patients, which will be trialled in Yorkshire and potentially rolled out to other ambulance services. Worcestershire Acute Hospitals NHS Trust has amended its guideline to include clear advice for all patients in the Emergency Department requiring admission, delivered teaching sessions to surgical trainees and T&O junior doctors, shared a lesson of the week, and made changes to ED admission documents to include prompts on time-critical medications. The Society for Endocrinology highlights existing resources and the NICE guideline in development, commits to reviewing resources once NICE guidelines are written and ensuring pre-hospital care is covered more clearly, and is liaising with ambulance services to ensure triage information includes the need to send a category 2 ambulance.