Deaths Following Heart Surgery Could Be Reduced

Patients and clinicians alike consider coronary bypass surgery to be routine and safe, but the latest findings from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) show that over a fifth of patients do not get best care.

NCEPOD has taken a critical look into coronary artery bypass grafts (CABG), and the strategy and organisational factors involved in its implementation, over a three year period.

There is an expectation that coronary artery disease can be effectively and safely treated. The report found the quality of care was adversely affected in two-thirds of patients due to poor organisation, communication and teamwork. The findings revealed that nearly half of health trusts do not follow Department of Health National Service Framework (NSF) protocols, seven years after their introduction.

Key recommendations include:

• Pre-operative investigations must be reviewed by a senior clinician.
• There should be a clear written management plan where pre-operative comorbidity exists.
• Senior clinicians should be readily available during the peri-operative period to manage possible complications without delay.
• Better use of NSF and other protocols and guidelines.
• Better record-keeping.
• A consultant should obtain consent for coronary artery bypass grafting.
• Improved multidisciplinary team communication and co-operation.

Improved organisation, co-operation communication and team work are at the heart of cardiac surgery, Mr Martin said: ‘Quality of care is as much about organisation of the service as it is about performing a good operation.’

Source: The full report is available on the NCEPOD website.

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