Medical negligence at heart of non-cardiac death risks

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According to leading surgeons, poor care and delays in treatment are risking the lives of thousands of non-cardiac NHS emergency surgery patients.A report by the Royal College of Surgeons (RCS) has said that poor access to facilities such as scanners and operating theatres slows down diagnosis.

Noting that not enough patients receive critical after-surgery care, the RCS added that inexperienced junior staff are often left to deal with complex and dangerous cases.

Medical NegligenceHighlighted figures in the RCS report show that some 170,000 patients have non-cardiac emergency operations each year. Of these, 100,000 develop complications and 25,000 die, with the mortality rate climbing to 40% among the elderly.

The non-cardiac category includes most major gastro-intestinal and vascular procedures, said the report. Emergency major abdominal surgery has one of the highest mortalities, which can reach 50% in the over 80s.

Iain Anderson, a consultant general surgeon at Salford Royal NHS Foundation Trust and the report's author, observed that the high-risk nature of emergency abdominal surgery was not being recognised.

"These are the largest abdominal and emergency operations and I think there's been a general failure to understand just how high risk this surgery is, by the patients, sometimes by the doctors but certainly by health service managers," he said.

The report also said that while survival rates vary from hospital to hospital, there can be significant day-to-day differences even within the same institution.

Calling on hospitals to provide faster access to operating theatres, the report questioned whether elective or planned surgery has been prioritised over emergency surgery, which could be linked to pressure on hospitals to reduce waiting lists.

Mr Anderson said that trusts need to acknowledge that problems exist and should review their services. "Every 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," he said.

Neil Fearn of Simpson Millar LLP acknowledged that cardiac surgery was clearly serious and often needed high priority. "However, problems are faced daily by overlooked non-cardiac patients, many of whom are left in the wrong wards and tended by juniors," he said.

"Emergency gastro-intestinal procedures still have to be performed on patients who, although critically ill, often appear to be the 'poor relations' in the NHS.

"The NHS needs a properly structured approach to emergency services, from the ambulance crews to managers and surgeons, otherwise intensive care units will continue to fill with patients who are tragically too unwell to be helped."

A Department of Health spokesman said the NHS was being modernised to improve results for patients and safety was at the heart of the service.

"It is essential that hospitals provide the safest possible care for patients," he said. "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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