Surgeons highlight plight of ‘forgotten’ emergency patients

Surgeons highlight plight of forgotten emergency patients 2227

[Picture by Richardo York]

Some of the NHS’s sickest patients are languishing on inappropriate wards and being treated by juniors with no plan in place to deal promptly with unexpected complications.

These are the words of the author of a Royal College of Surgeons’ (RCS) report into the treatment of patients undergoing emergency surgery.

The report, which is sub-titled ‘Towards Improved Care for a Forgotten Group’, concludes that there is a “general lack of appreciation” in the level of risk in emergency surgical patients. 

Of the 170,000 patients who undergo emergency non-cardiac operations each year, 100,000 will develop complications and 25,000 will die. 

Emergency non-cardiac operations include abdominal surgery such as opening up the abdomen (belly) to remove an inflamed appendix resulting from appendicitis. Complications involving this type of surgery can include bleeding, infection and shock and the mortality rate of this procedure is as high as 50 per cent among patients aged over 80.

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However, the report suggests that some patients are more vulnerable to neglect than other – more because of a lack of organisation from health care trusts than a failing on the part of individual doctors, nurses or surgeons.

The new report highlights how an emergency patient’s risk of dying can “more than double” depending on which NHS hospital they are treated in. 

Complications can also vary within the same hospital depending on the time of admission.

Report author Iain Anderson, a consultant general surgeon at Salford Royal NHS Foundation Trust, said: “Trusts should acknowledge that these problems exist and work to review their services using this guidance.” 

He added: “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.”

The report urges health trusts to provide fast access to operating theatres for emergency patients and “prioritise emergency cases over elective surgery whenever possible”. 

The RCS is unequivocal in its belief that all high-risk patients should be admitted to critical care after surgery. However, due to a shortage of critical care beds, only a third of high-risk patients receive this level of care and those that do are typically discharged after only 24 hours.

Norman Williams, the 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 some NHS hospitals.”

It remains to be seen whether Prime Minister David Cameron will address these concerns when he makes his speech at the forthcoming Conservative party conference.