Sheffield research: Improvements in care could save the lives of more acute bowel obstruction patients

University of Sheffield | January 2020 | Improvements in care could save the lives of more acute bowel obstruction patients

Matt Lee, an NIHR Clinical Lecturer in General Surgery at the University of Sheffield Medical School, led a National Audit of Small Bowel Obstruction in 2017. 

The study identified the key causes of delays to treatment, finding that in a little over a fifth of cases, there was a delay in providing a CT scan of the patient. In these cases, 61 per cent of patients were then subsequently delayed in being diagnosed.

This compared to just six per cent if there was no delay in diagnostic imaging. Following diagnosis, around 20 per cent of patients saw a delay to their surgery, which in all cases was either due to an operating theatre not being available, or there being no anaesthetist.

Delay in Transit, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), reviewed 686 cases of patients aged 16 and over, in an attempt to improve the high mortality rates for the condition which are currently at around 10 per cent in cases where surgery is needed.

Lee said: “There are over 22,000 admissions for bowel obstruction in England and Wales each year, of whom 6.4 per cent will die within 90 days.

  • A study by the National Confidential Enquiry into Patient Outcome and Death has discovered “significant opportunities” to improve patient care for those with acute bowel obstruction
  • Around 6.4 per cent of patients admitted each year die within 90 days
  • The report identified recurring delays at every stage of the treatment process
  • It also found room for improvement in post discharge care
  • A new report has shared recommendations to improve the chance of survival for patients with acute bowel obstruction.

There was also found to be room for improvement in clinical care, with only 55 per cent of patients being subject to an “adequate” risk assessment, and only 38 per cent having a nutrition assessment when they were discharged.
Delay in Transit makes a series of 11 new recommendations for caring for those with acute bowel obstruction, including:

  • Undertaking a CT scan with intravenous contrast promptly to ensure timely diagnosis.
  • Undertaking a consultant review in all patients with acute bowel obstruction as soon as clinically indicated, and within 14 hours of admission at the latest
  • Measure and document the hydration status of those presenting with symptoms of acute bowel obstruction to minimise the risk of acute kidney injury
  • Ensure local policies are in place for the escalation of patients requiring surgery to enable rapid access to an operating theatre.
  • Minimise delays to diagnosis and treatment by auditing the time taken between each step in the patients’ treatment (Source: University of Sheffield)

Full news release here 

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