Poor communication is a significant factor in patient deaths in an emergency or urgent setting, a confidential review into the care of over 3,000 terminal patients finds.
In 13.5% of cases a lack of communication both between different grades of doctors within clinical teams, and between different clinical teams and other health care professionals was noted.
The hard-hitting report by the National Confidential Enquiry into Patient Outcome and Death also reveals two-fifths of patients received ‘sub-standard’ care, highlighting problems with the involvement of patients and their families, continuity of care and a lack of senior input, particularly at night.
Deaths in acute hospitals: caring to the end? finds that a coordinated handover of patients between night and day staff only occurred in a quarter of the teams, prompting calls for new systems that enable clinical teams to have a better understanding of a case throughout a hospital stay.
More prompt review of patients by consultants is also urged. The report claims there was a clinically important delay in the first consultant review in 25% of cases.
The report’s author said: “Change in the hospital team structure over recent years has seen individual clinicians become transient acquaintances during a patient’s illness rather than having responsibility for continuity of care.
“Staffing arrangements and shift working have also been shown to be disruptive and with the implementation of the European Working Time Directive, this disruption is likely to continue and to impact on the training of tomorrow’s doctors.”
In 16.9% of patients who were not expected to survive on admission there was no evidence of any discussion between the health care team and either the patient or relatives on treatment limitation. In 21.8% of cases DNAR orders were signed by very junior trainee doctors.
Mr John Black, president of the Royal College of Surgeons, blamed multiple handovers. “This report highlights the loss of proper team working in hospitals, resulting in dangerous failures of communication which make it harder and harder for clinicians to provide safe care for patients,” he said.
“The problems revealed in this report date from 2006 and 2007, when the NHS was already struggling to meet the demands of a 56-hour working week. Now that, in theory, everyone in the NHS is working for only 48 hours the situation in the country’s hospitals can only have worsened.”
The college called for an opt out from the WTD so that ‘proper’ clinical teams can provide on-call cover throughout a 24-hour period.
Read the full report.
Tags: Communication, Continuity of care, WTD
It would appear that, at long last, the profession has woken up to the problems of the EWTD - forecast by many when first agreed by Govt about 10 years ago! The EWTD was never intended for the professions - and no one training for any of the professions has ever worked only 48hrs per week; nor do they restrict their working hours to 48 when they are trained. There should be a concerted effort by ALL the professions to have them excluded. However, to deal with the immediate problem , particularly in relation to trainees in medicine (and especially surgical trainees) there needs to be an agreement to separate ‘training’ from ’service’ - and an acknowledgement that ‘out of hours’ cover is not really training (unless properly supertvised); if we are to have a ‘consultant based’ service then it must cover the whole 24 hours - not just the ‘day time’. Retired Orthopaedic Surgeon