29 May 2013
Why are you at a higher risk of dying if you have your operation later in the week?
I have been on Sky News today, discussing NHS weekend death rates with Gary Walker, former Chief Executive of Lincolnshire NHS Trust.
Research issued today stated that patients who have planned surgery near the end of any week or at weekends are at greater risk of dying than those operated on at the start of the week and especially on Mondays.
The research, by Imperial College London, found that the risk of death within 30 days of a planned operation increased every day of the week after Monday.
Compared with Monday, the adjusted odds of death for all elective surgical procedures was 44% higher, and 82% higher, if the procedures were carried out on Friday or at the weekend respectively.
The same trend was recorded among patients having lower-risk procedures. The rate of death was 1.8 per 1,000 admissions for those having surgery on a Monday but rose to 2.4 – some 33% higher – on a Friday.
My colleagues and I frequently find that the first 48 hours after surgery are critical to patients' chances of recovery, the poorer care available at weekends – fewer staff, less experienced staff, perhaps less access to diagnostic tools or emergency surgery – leads to a worse outcome. Lack of weekend consultant staff is believed to be a problem at 1 in 3 hospitals.
One tragic example of poor weekend practice is a case in which I am currently acting. A patient was admitted to hospital with a life threatening condition – a Sub Arachnoid Haemorrhage - at 5pm on a Friday. He was advised that although he needed an urgent procedure to stop a second potentially fatal bleed, the Hospital had a policy that such cases would be routinely left untreated from Friday night to Monday morning. The team of staff needed for the “clipping” procedure was large and costly to assemble at the weekend.
The doctors took no steps to locate an alternative hospital who could treat him at the weekend. Additional head injury patients were admitted over the weekend and my client was not treated first thing on Monday morning, as he was promised.
He suffered a second catastrophic bleed at 5pm on the Monday and has suffered a major, life altering Brain Injury. All of this was totally avoidable if a rota of available hospitals for such cases had been organised. The doctors essentially took a massive risk that patient would remain stable for 3 days but tragically he did not. This is not an isolated case. In London alone, it is estimated that 500 patients a year die unnecessarily due to weekend rotas.
My point to Sky News that it is a false economy to fail to offer a 7 day a week service when the fall out from the 5 day a week service is a raft of high value claims and lives turned upside down.
By Clinical Negligence Solicitor James Bell.