The First Patient Report of the National Emergency Laparotomy Audit released today concludes that patients are dying following emergency surgery (surgery on the stomach and bowels) due to a wide variation of care between hospitals including delays of more than 12 hours before seeing a consultant.
The study of more than 20,000 patients from 192 hospitals found that one in 10 patients died within 30 days of undergoing urgent, unplanned laparotomy (bowel surgery), and some of these deaths could be avoided.
The National Emergency Laparotomy Audit, commissioned by the Healthcare Quality Improvement Partnership, found that only half of patients were seen by a consultant surgeon within the recommended 12 hours. One in six patients did not arrive in the operating theatre within the recommended timeframes, despite the urgent nature of the surgery.
Similarly, a previous review of acute medicine and general surgery in 2014, undertaken by Dr Foster Intelligence, initiated by consultants, uncovered that there were major variations in the quality of care provided across hospitals in Greater Manchester. This variation is leading to patients dying unnecessarily. Patients are twice as likely to die after general surgery in some Greater Manchester hospitals than others.
The findings from both reports reinforce the Healthier Together proposals and the need to change the way some hospital services are delivered. There are three elements to the Healthier Together programme – Integrated Care, Primary Care and Hospital Care. Clinically led and driven by doctors, the programme aims to provide the best health and care for patients across Greater Manchester.
Under the Healthier Together hospital plans to drive up quality and safety, ‘single services’ will be formed – networks of linked hospitals working in partnership. This means care will be provided by a team of medical staff who will work together across a number of hospital sites within the single service. One of the hospitals within each network will specialise in emergency surgery and in general surgery (surgery on the stomach and bowels). Extra consultants will be recruited and will perform these specialised procedures continually.
Nick Lees, a consultant general surgeon at Salford Royal Hospital, said: “This is precisely why we need to change the way we work across hospitals. There are too many inconsistencies in outcomes and patients are having to wait too long to see a consultant, we are risking lives.
“A relative of mine underwent an emergency laparotomy 14 hours after she attended A&E, so I know this is a reality in Greater Manchester, both from my daily work and personal experience. By the time she was operated on, some bowel had died and had to be removed. There is a shortage of consultant specialists, especially at night and weekends, and patchy use of critical care beds.
“Currently none of our hospitals meet all of the national quality and safety standards. In some of our hospitals 50% of these life-saving operations are performed by junior doctors, not consultants.
“Under Healthier Together, an additional 35 consultants will be recruited across hospitals and all hospitals will be improved and continue to serve their local populations. It is estimated that with these changes there will be about 300 fewer deaths each year after general surgery.”
On Wednesday 17th June, the Healthier Together Committees in Common (CiC), comprising of members of the 12 Clinical Commissioning Groups in Greater Manchester, decided that four single services be the best way to create sustainable services and start saving lives most quickly.
A meeting will take place on Wednesday 15th July for the CiC to decide which hospitals will work in partnership as single services and which hospitals will specialise in general surgery and emergency medicine as part of that single service.