Disturbing report reveals lack of care for high-risk patients

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More than half of high-risk patients undergoing surgery do not receive good care, according to a study which paints a “disturbing” picture of some NHS services.

Too many patients are put back on general wards after surgery rather than being sent to critical care, thereby increasing their risk of death, the damning report said.

Experts from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) also said a significant number of hospitals are not well equipped for dealing with surgical patients, whether high or low risk.

Data was collected for more than 19,000 patients across 300 UK hospitals.

A case review also examined 829 high-risk patients (who make up about 10 per cent of patients who have surgery in the UK) in detail.

In the general population, about one per cent of people can be expected to die after undergoing surgery but this rises to 10 per cent to 15 per cent of high-risk patients.

In the study, almost 20 per cent of high-risk patients whose surgery was planned were not seen in a pre-assessment clinic, which led to higher death rates among this group.

And only 22 per cent of high-risk patients were sent to critical care following surgery. Among those patients who were sent to other wards and where experts believed this was the wrong decision, the death rate was more than three times higher.

“It seems shocking that 74 high risk non-elective patients went to a ward after surgery and died there with no escalation to critical care,” the report said.

“Of the 165 high risk patients who died, 80 were never admitted to critical care.”

Even those patients who were eventually moved to critical care had a higher chance of dying than those who went there straight after surgery.

Experts also found patients not being told about their risk of death, with only 7.5 per cent of high-risk patients having their estimated risk put in their notes.

Of all patients in the study, 79 per cent of those who died were regarded as high-risk.

In his foreword to the report, NCEPOD chairman, Bertie Leigh, said the study painted a “disturbing” explanation of why the UK has poor results compared to other countries, including the United States.

“The short answer seems to be that people die because we do not give them the level of care they are entitled to expect,” he said.

“The results of this prospective study of all the surgery carried out over one week demonstrate that there is a long way to go in this country before we can suggest that we have reached an acceptable position.”

The report also analysed a hospital’s ability to cope with all surgical patients.

It found 12 per cent of hospitals had no policy for recognising an acutely ill patient, despite a lack of this being widely recognised as a “major patient safety problem”.

Some 34 per cent of hospitals had no critical care outreach team, 16 per cent did not have anaesthetic clinics designed to assess risk before admission while 17 per cent did not have pre-admission surgical assessment clinics.

Most hospitals had a recovery area for those patients coming round from anaesthetic but only 67 per cent had this in use 24 hours a day, seven days a week.

Almost a quarter (23 per cent) of hospitals could not provide ventilatory support and ongoing management of patients in this room.

And 64 per cent could only provide this support for short periods of time (up to six hours).

The report said cases were now more complex than a decade ago, with two-thirds of those in the study overweight and patients getting older.

But it said: “The difficulty is that the NHS generally does not seem to be rising to the challenge.”

“Recommendations in the report include introducing a UK-wide system for rapid and easy identification of patients who are at high-risk of dying or suffering complications after surgery, and for all high-risk patients to be seen and “fully investigated” in pre-assessment clinics.

Dr George Findlay, NCEPOD’s clinical co-ordinator and intensive care consultant, said: “There appears to be a serious lack of awareness of the degree of mortality risk to patients.”