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Your support makes all the difference.The lives of thousands of patients are being threatened in the vital days following operations by a "substantial" shortfall in critical- care facilities in British hospitals, leading doctors warned yesterday.
Their independent report says that "scarce and expensive" intensive-care beds are being misused, and are not available to more-needy patients, because doctors have nowhere else to put post-operative patients. Other patients are being returned too soon to the "relatively unsafe environment" ofthe general wards, where nursing and medical care is less intensive. Many more patients who need urgent or emergency surgery are forced to wait for hours until operating theatres become available, because few hospitals have designated emergency theatres.
The latest report of the National Confidential Inquiry into Perioperative Deaths (NCEPOD), which analysed almost 20,000 post-operative deaths in patients aged between 6 and 70 years, between April 1992 and March 1993, paints a grim picture of the state of critical care in the health service and some private hospitals.
Only one in five of the hospitals had high-dependency units - intermediary wards with a higher nurse-to-patient ratio than general wards, but less than that provided in intensive care. One in 10 did not have a recovery room where patientscould recover from anaesthesia.
Professor John Blandy, chairman of the inquiry, said: "Any hospital admitting emergency patients, and hospitals admitting complex elective patients, must have adequate facilities for intensive or high-dependency care at all times." Up to 36 per cent of the emergency or urgent operations analysed in the report were performed "out of hours" - between 6pm and 8am on weekdays, and at weekends - indicating that the patients were kept waiting for theatres. Only a third of hospitals are believed to have operating theatres dedicated to emergency surgery, and there was anecdotal evidence that some were being closed or misused by trust hospitals under pressure in other areas.
The NCEPOD survey is based on questionnaires returned by more than 3,000 consultant surgeons and anaesthetists in England, Wales and Northern Ireland, and makes nine recommendations for the improvement of patient care. It also highlights poor medical record-keeping and loss of notes as problem areas, and emphasises previous recommendations that trainees with less than three years' experience should not anaesthetise or operate without supervision.
Gerald Malone, Health Minister, said that the Department of Health was already tackling problems on the best use of intensive care and high- dependency beds.
n The Report of the National Confidential Inquiry into Perioperative Deaths 1992/1993; 35-43 Lincoln's Inn Fields, London WC2A 3PN; pounds 10.
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