U.K. Royal College responds to laparotomy audit

Improved facilities and better teamwork could help to improve the care received by patients who undergo emergency laparotomies in England and Wales, according to a study by U.K. National Emergency Laparotomy Audit (NELA).

According to NELA, previous studies have found that patients undergoing emergency surgical procedures to treat life-threatening abdominal conditions have a high risk of death and serious complications following surgery. Of the 30,000 procedures performed annually, there is an estimated 15% mortality within the first month following surgery.

NELA evaluated current processes and resources for emergency abdominal surgery at 190 hospitals in England and Wales and found wide variations across healthcare facilities. While many hospitals meet current standards of care, NELA reported, there are some areas where improvements could help ensure that all patients who need an emergency laparotomy receive the highest standard of care.

Other findings indicate that:

  • Four-fifths of hospitals admitting unscheduled adult general surgical patients provide one or more fully staffed operating theaters in which emergency laparotomy may be performed at all times.
  • Nine out of 10 hospitals have 24-hour CT reporting available.
  • There are diverse levels of clinical staffing in place, which may have an impact on the delivery of care. Patient-level data will be essential in clarifying this.
  • The implementation of clinical pathways for the care of patients undergoing emergency laparotomy varies widely across hospitals.

The Royal College of Radiologists (RCR) stated that the report confirms its concerns regarding the availability of interventional radiology. The organization supports a multidisciplinary approach to increase patient access to interventional radiology.

In a prepared statement, the college said it is "very concerned about the apparent finding that some patients are not benefiting from a radiologist's report at the time of emergency abdominal CT scanning. In our view, this falls well below an acceptable standard of patient care."

The college has asked NELA to clarify this finding. If it is confirmed, the situation would be a "very serious matter adversely affecting patient safety requiring urgent attention," the statement concluded

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