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Emergency surgical patients neglected and put at risk

Surgeons call for radical shake-up to save lives

Jo Carlowe

Thursday, 29 September 2011

Surgical patients are missing out on life-saving care due to poor access to emergency operating theatres and radiology.

The Royal College of Surgeons in its report: The Higher Risk General Surgical Patient: Towards Improved Care for a Forgotten Group, published today, called on the NHS to address ‘the significant variations in care’ experienced by the 170,000 patients who have major abdominal surgery each year.

As well as talking about lack of access and the poor design of hospital services, the report said there was a lack of ‘appreciation’ of the level of risk in emergency surgical patients – where death rates of 15-20% are typical and can be as high as 40%.

Surgeons say this imminent risk of death is not being reflected in the priority given to these patients whose chances of survival can more than double, depending on which NHS hospital they are treated in.

The RCS in its report says complications and deaths could be reduced by implementing its recommendations.

Among the recommendations is the need for fast access to operating theatres within defined time periods, with emergency cases prioritised over elective ones where necessary.

“It may be that separation of planned and unplanned operations is necessary,” says the report.

Routine risk assessment and tailored management of every patient, is also recommended, along with better use of critical care services. Due to a limited number of critical care beds, less than a third of high risk NHS patients are currently admitted to critical care following surgery.

Mr Iain Anderson, report author and Consultant General Surgeon at Salford Royal NHS Foundation Trust, said: “Every acute hospital in the UK deals with many emergency patients every single day, among who three or four will typically meet these higher risk criteria. Complications and death rates vary significantly between hospital and even within the same hospital depending on the time of admission. Trusts should acknowledge that these problems exist and work to review their services using this guidance. Every single emergency patient who comes through the door of an NHS hospital should have an individual risk assessment, diagnosis, treatment plan and post operative care plan prioritised according to need. Instead we have some of the NHS’ sickest patients languishing on inappropriate wards, treated by juniors and with no plan in place to deal promptly with unexpected complications.”

Norman Williams, President of the RCS, said: The focus on reducing waiting times for elective procedures has resulted in a large group, of mostly elderly patients, becoming seriously under prioritised to the point of neglect in the some NHS hospitals......we are calling on all surgeons and managers to work together to deliver the high quality care that these patients need and which some hospitals are already proving can be delivered.”

Responding to the RCS report, a Department of Health spokesperson said: “We have made clear that safety must be at the heart of the NHS. It is essential that hospitals provide the safest possible care for patients.

“Hospitals should follow this guidance and monitor the quality of care they are giving to their patients and ensure that they are providing appropriate levels of services and staffing."

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