Emergency surgery patients must have higher priority in NHS hospitals, new standards reveal.
The Royal College of Surgeons’ report reveals that there’s too much variation in mortality and complication rates for emergency patients.
Emergency surgery patients comprise about 50% of surgical work, and in general surgery alone accounts for 14,000 admissions a year to intensive care in England and Wales - at a cost of £88m and mortality rates of 25%.
The report demonstrates that there is a lack of detailed outcome measurement for emergency surgery patients - which is preventing hospitals from understanding how they can improve.
Surgeons believe that dedicated operating theatre time for emergency cases; better care for high-risk patients before and after surgery; and greater availability of consultants would save lives and shorten hospital stays for emergency patients.
The standards, entitled Emergency Surgery: Standards for unscheduled surgical care, offer the new GP commissioning consortia detailed specialty-by-specialty advice on the clinical standards for emergency surgical care that should be met by hospitals they send patients to.
All critically-ill patients would benefit from these standards being followed, but surgeons believe elderly and frail patients would do so most of all.
The report calls for improved timeliness of surgery and better access to theatres. Access to theatres is inadequate with priority often given to elective cases in order to meet arbitrary targets, it says.
Better access to consultant care is also demanded. Consultant surgeon job plans need more time allocated for the initial assessment and treatment of emergency cases, as recommended by the College of Emergency Medicine.
The standards also call for hospitals to develop clear, defined diagnostic and monitoring plans for patients as they are admitted. Routine and on-going risk assessment of patients must occur, with those deemed high risk automatically flagged for closer levels of monitoring and attention from senior doctors.
Other suggestions include dedicated wards and access to critical care, and relaxation in the 48-hour week for juniors.
Mr Richard Collins, vice-president of the RCS and chair of the working group which produced the standards, said: “In recent decades, UK hospitals have been encouraged and financially rewarded to reduce waiting times for planned operations. This has come at a cost as care for emergency patients has been institutionally neglected.
“These patients are often left languishing while they wait for an operation, suffer from a lack of access to senior doctors and receive sub-optimal post-operative care. They deserve better. We have to put this right and GPs are now in a strong position to support hospital colleagues in achieving these standards by voting with their feet and putting resources to hospitals which provide the right care.”
The Intensive Care Society’s Dr Carol Peden added: “If we are to operate on high risk patients then it is essential that we provide the right level of care for them after their surgery. There must be an appropriate number of critical care beds to manage these patients in the most cost effective and efficient way. Only by doing this will we be able to reduce the postoperative mortality.
Read a supporting letter to The Telegraph by leading medical bodies.