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 

Digital interventions could help reduce smoking and obesity

In a new draft guideline, NICE says that digital interventions such as apps, wearable devices and online programmes and websites may help people achieve health goals. This includes helping people to be more physically active, manage their weight, quit smoking, reduce alcohol intake or reduce unsafe sexual behaviour.

Health professionals can consider digital and mobile interventions as a supplement to regular services to support behaviour change in people at risk of developing chronic conditions. The recommendations are in line with the NHS Long Term Plan, though NICE says the digital tools should be offered in addition to existing health and care services, not as a replacement.

While highlighting the potential benefit of digital interventions, the NICE recommendations acknowledge possible complications with their use and urge clinicians to take care that patients do not rely on the apps as a way of avoiding seeing a professional. The guideline also points to the uncertainty of their effectiveness when used alone and recommends them only as supportive tools in addition to regular services.

It is therefore recommended that healthcare professionals advise patients on digital interventions as appropriate, on a case by case basis.

A consultation on the draft recommendations is open until 6 March 2020.