Doctors say
hospitals need to improve care for “high risk” patients, such as the very old.
Doctors
concede that there is simply not the money to provide such a level of care for
all patients.
Enter the Communitarian solution - the Liverpool Care Pathway...
The Telegraph has
this report (emphases are mine throughout) -
Surgery death rate 'twice as high as thought'
Twice as many people die after surgery in NHS hospitals as previously thought, according to a new report that finds serious shortcomings in the way many patients are treated. |
| People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors, often because hospital staff were not identifying them properly. Photo: GETTY |
7:00AM BST 21 Sep 2012
The overall chance of dying
within two months of surgery is one in 28 (3.6 per cent), found the study
published today (Fri) in The Lancet.
Dr Rupert Pearse, who led
the research, described its findings as “very worrying” and said many patients
were simply not getting the care they should. “We need to act,” he said.
People at a high risk of
dying from surgery were routinely not being told of the dangers, said doctors,
often because hospital staff were not identifying them properly.
Patients were also being
sent back to general wards after surgery rather than critical care beds because
of a “one-size fits all” approach that was “ingrained” in the NHS.
Dr Pearse, a reader in
intensive care medicine at Barts and the London School of Medicine and
Dentistry, said lessons needed to be learnt from cardiac surgery, where
information on death rates was freely available and hospitals vied to be the
best.
A previous report, published
last December by the National Confidential Enquiry for Patient Outcome and
Death (NCEPOD), found the chance of dying within 30 days of surgery was just
one in 63 (1.6 per cent).
But Dr Pearse said the
difference between the two figures could not simply be explained by more
patients dying in the second month.
“The great majority of
deaths happen in the first seven to 10 days after surgery.”
Dr Pearse, an intensive care
specialist, designed both the NCEPOD and the Lancet study, but said the latter
was “more robust” regarding mortality rates.
He warned: “We’ve always
known that we had a problem, but this study shows it’s more serious than
previously thought. It’s very worrying and we need to act.”
The latest study examined
10,630 cases in British hospitals during one week in April 2011. These included
both pre-planned and emergency operations, but excluded those not requiring an
overnight stay, as well as cardiac, neurological, radiological or obstetric
surgery.
Patients undergoing
specialist surgery are treated differently, for example by dedicated teams on
dedicated wards. Dr Pearse argued that meant they essentially received better
care.
He said the mortality rate
among adult cardiac patients was now less than two per cent - even though they
tended to be older, have worse health, and require more dangerous surgery than
average.
“If we did the types of
things that we did in cardiac surgery, in all types of surgery, outcomes would
improve.
“With most surgery, the only
thing that’s different is the surgeon. But this ‘one size fits all’ approach to
care isn’t really working for the overall surgical population.”
Cardiac patients are treated
by specialist teams of surgeons and anaesthetists and cared for by specialist
nurses on dedicated wards.
Dr Pearse also said outcomes
for cardiac surgery had improved markedly since the mid 90s, partly due to
changes triggered by the Bristol Royal Infirmary scandal. Between 1990 and
1995, 35 babies died in its cardiac unit and dozens more were brain damaged due
to lack of staff, leadership, and scrutiny.
This led to cardiac units
being constantly audited, with results now published online.
“I think the reason we see
such amazing care and excellent outcomes with cardiac surgery, is that
hospitals compete with each other,” he said.
“If they find that their
hospital is below par, they want to improve it.”
Doctors concede that there
is simply not the money to provide such a level of care for all patients.
But they say hospitals need
to improve care for “high risk” patients, such as the very old or those
undergoing dangerous procedures like emergency bowel repairs, who account for
80 per cent of deaths.
However, Dr George Findlay,
main author of the NCEPOD report, said “poorly organised services” meant
hospitals too often failed to identify these patients. This meant some went
under the knife when their chances of survival were slim.
He continued: “Risk is very
poorly stated to the patient: very few have a statement of risk on their
consent forms.”
Patients also encountered
serious problems after surgery, he said.
“There are a lot of high
risk patients who are just sent back to a normal ward, where they don’t have an
optimal chance of recovery,” he noted.
“That’s so ingrained, it’s
happened in the NHS for so many years, that it’s an accepted thing.”
However, he said that for
most patients, who were relatively well and fit, the chances of dying from
surgery were very low.
Medicine is
also an 'art' and predicting death is not a hard and fast 'science'.
Doctors take
the lives of their patients in their hands, effectively, as would gods the
lives of mere mortals.
But nothing
is ever a foregone conclusion: doctors are not Gods; they cannot tell with
certainty, and must work not with assumption or protocol, but with the
situation and the individual.
The more care, the better the outcome. But care costs money. Far better a set of cost-effective protocols.
What is a
life worth?
There are no
'untermenschen', but there are 'ubermenschen'.
