Update to The High-Risk Surgical Patient released by RCS England

Patients who need to undergo high-risk emergency abdominal surgery are being discriminated against, as finite NHS resources, such as consultant staff, operating theatres and critical care beds, are still systematically targeted at lower-risk patients having planned procedures, a report from the Royal College of Surgeons (RCS) has warned. These patients may have potentially life-threatening conditions such as bowel obstructions, strangulated hernias or peritonitis.

An RCS report published today (21 December), The High-Risk General Surgical Patient: Raising the Standard, says that while there have been some improvements in care for patients needing high-risk abdominal surgery in recent years, notably for those patients undergoing emergency laparotomy who now benefit from greater consultant involvement and increased access to critical care beds, current evidence indicates that many patients still receive surgical care that is unreliable with respect to diagnosis, recognition of deterioration and provision of high-quality treatment.

The report's authors warn that some patients are suffering avoidable harm and on occasion dying, waiting for antibiotics, scans, procedures, operations or critical care beds because care is not focused enough on their life-threatening conditions. Today's report is an update on standards published by the RCS in 2011 to improve the care of high-risk general surgery patients. The RCS says the updated standards should be mandatory in all acute hospitals with adult general surgical services.

Mr John Abercrombie, Royal College of Surgeons Council Member, and a Consultant Surgeon, said:

"There have been modest improvements since the RCS published standards in 2011. The most important improvement has been the establishment of the National Emergency Laparotomy Audit (NELA) which tracks data from all providers of emergency laparotomy, so that units can compare their performance to others and make the changes necessary to provide high quality care.

"That said, we cannot be complacent. There is still too much variation in the standard of care that these very ill general surgery patients receive. Hospitals need to think carefully about how resources are allocated between planned, urgent and emergency pathways so that all groups of patients get the best possible care."

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