The care given to many patients having heart bypass surgery may be flawed, according to an expert report.
The care given to many patients having heart bypass surgery may be flawed, according to an expert report.
The NCEPOD study suggested that as many as one in five of the 20,000 patients a year undergoing the operation do not get the best possible care.
The NCEPOD study suggested that as many as one in five of the 20,000 patients a year undergoing the operation do not get the best possible care.
Among a third of those who did not survive, delays were partly to blame, it said.
Among a third of those who did not survive, delays were partly to blame, it said.
The NHS said the UK was a world-leader in cardiac surgery, and pledged to work closely with the report's authors.
The NHS said the UK was a world-leader in cardiac surgery, and pledged to work closely with the report's authors.
If the means at our disposal are not deployed effectively and in a timely way, appropriate to the circumstances, lives that might have been saved will be lost Professor Tom TreasureNCEPOD
If the means at our disposal are not deployed effectively and in a timely way, appropriate to the circumstances, lives that might have been saved will be lost Professor Tom TreasureNCEPOD
NCEPOD, short for the National Confidential Enquiry into Patient Outcome and Death, looks for lessons that can be learned from deaths or poor results over a wide range of medical care.
NCEPOD, short for the National Confidential Enquiry into Patient Outcome and Death, looks for lessons that can be learned from deaths or poor results over a wide range of medical care.
Coronary artery bypass graft operations, the focus of their latest project, has approximately a 2% death rate, and over the three year period checked, there were 1,198 deaths reported.
Coronary artery bypass graft operations, the focus of their latest project, has approximately a 2% death rate, and over the three year period checked, there were 1,198 deaths reported.
Focusing on cases at 39 NHS hospitals and 19 private hospitals, the investigators looked at the care of patients who did not survive, from the moment of referral onwards.
Focusing on cases at 39 NHS hospitals and 19 private hospitals, the investigators looked at the care of patients who did not survive, from the moment of referral onwards.
There were problems found in every step of the process, from delays after referral, to the way tests were carried out, doctors communicated with each other, and the way patients were cared for after their operations.
There were problems found in every step of the process, from delays after referral, to the way tests were carried out, doctors communicated with each other, and the way patients were cared for after their operations.
Overall, they concluded that in two-thirds of cases which ended in the death of a patient, some aspect of care was flawed, due to poor organisation, communication or teamwork.
Overall, they concluded that in two-thirds of cases which ended in the death of a patient, some aspect of care was flawed, due to poor organisation, communication or teamwork.
Nearly half of all NHS Trusts were found not to be following Department of Health guidance, even several years after its introduction.
Nearly half of all NHS Trusts were found not to be following Department of Health guidance, even several years after its introduction.
Delays and administrative failures in the system came in for particular criticism, with clear evidence that delays made the outcome of the operation worse in 33% of the cases examined.
Delays and administrative failures in the system came in for particular criticism, with clear evidence that delays made the outcome of the operation worse in 33% of the cases examined.
In one case cited, a patient with heart disease was referred to a consultant surgeon by a cardiologist, but the letter went unopened for a month because the surgeon was on holiday.
In one case cited, a patient with heart disease was referred to a consultant surgeon by a cardiologist, but the letter went unopened for a month because the surgeon was on holiday.
In the meantime, the patient's condition deteriorated, and he died after surgery.
In the meantime, the patient's condition deteriorated, and he died after surgery.
'Complacency'
'Complacency'
The Chairman of NCEPOD, Professor Tom Treasure, said that heart bypass surgery was a "tried and tested means" of saving the lives of people with heart disease.
The Chairman of NCEPOD, Professor Tom Treasure, said that heart bypass surgery was a "tried and tested means" of saving the lives of people with heart disease.
However, he added: "Coronary surgery will not always succeed and death comes to us all in the end but if the means at our disposal are not deployed effectively and in a timely way, appropriate to the circumstances, lives that might have been saved will be lost."
However, he added: "Coronary surgery will not always succeed and death comes to us all in the end but if the means at our disposal are not deployed effectively and in a timely way, appropriate to the circumstances, lives that might have been saved will be lost."
Another of the NCEPOD study authors, surgeon Ian Martin, said: "Although the death rate is very low, there is no room for complacency, as improving the quality of care for these patients may have saved more lives."
Another of the NCEPOD study authors, surgeon Ian Martin, said: "Although the death rate is very low, there is no room for complacency, as improving the quality of care for these patients may have saved more lives."
Guideline call
Guideline call
The report contained a list of recommendations, urging cardiac surgery teams to follow national guidelines, and write clear "management plans" in cases where patients had other conditions which could increase the risk of surgery complications.
The report contained a list of recommendations, urging cardiac surgery teams to follow national guidelines, and write clear "management plans" in cases where patients had other conditions which could increase the risk of surgery complications.
Professor Sir Bruce Keogh, the NHS Medical Director, said the report provided some "very helpful" pointers towards improving care.
Professor Sir Bruce Keogh, the NHS Medical Director, said the report provided some "very helpful" pointers towards improving care.
"England already has the best results for cardiac surgery in the world and it is encouraging that NCEPOD recognises this.
"England already has the best results for cardiac surgery in the world and it is encouraging that NCEPOD recognises this.
"Cardiothoracic surgeons have led the way in publishing their outcome data and scrutinising what they do.
"Cardiothoracic surgeons have led the way in publishing their outcome data and scrutinising what they do.
"We will continue to work closely with them to ensure that patients get the highest possible standard of care".
"We will continue to work closely with them to ensure that patients get the highest possible standard of care".
A spokesman for the British Heart Foundation welcomed the drive for higher standards, but said: "Patients undergoing surgery in the UK should be reassured this operation is very successful and the survival rates are very high."
A spokesman for the British Heart Foundation welcomed the drive for higher standards, but said: "Patients undergoing surgery in the UK should be reassured this operation is very successful and the survival rates are very high."
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