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Navan op review finds no negligence
[Posted: Wed 27/07/2011 by Niall Hunter, Editor www.irishhealth.com]
A review of four keyhole surgery cases performed last year at Our Lady's Hospital in Navan has found the surgeons involved made no negligent errors in operating on the patients concerned but that there were deficiencies in record-keeping and patient communication.
The HSE has said that as a result of the findings of the external review, which it ordered last year, surgical services previously suspended at Navan will, subject to certain safeguards, be reintroduced on a phased basis.
The health executive has expressed regret for any upset caused to patients and their families following the publication of the review and also said it regretted any perceived slight to hospital staff as a result of the actions it took.
The probe findings published today found no negligent errors in surgical technique in relation to the practice of laparoscopic (keyhole) surgery by any of the three surgeons at Navan.
The independent review concluded that deficiencies in record-keeping and communication did not contribute to an adverse outcome for one of the keyhole surgery patients who is now deceased and did not influence clinical outcomes in the three other cases.
The four gall bladder keyhole surgery cases studied all had outcomes that were not as anticipated, with complications taking place. The health executive said while the review was being conducted, surgical services at Navan had been restricted 'as a precautionary measure.'
The results of the review are likely to add to the controversy about how and why the HSE made a decision last year to suspend surgery under general anaesthetic at the hospital, including keyhole procedures, on safety grounds.
It could also potentially weaken the Government and the HSE's case about the safety of services at smaller hospitals and the need to transfer them to larger centres, as in the Navan case at least, supporters will say that services there have been proven to be safe.
The HSE's hospital reconfiguration policy, however, is unlikely to change substantially and it could argue that the Navan report underlines its case that some minor surgery can still be carried out at smaller hospitals, even if they lose more complex surgery, provided certain safeguards are met.
However, the HSE is open to criticism on its handling of the Navan case, in particular on whether its suspension of some surgery last year and its launch of the review were justified on safety grounds, and following its admission today that its actions in relation to Navan may have unfairly questioned the reputations of staff.
The review indicates that the HSE was too hasty in suspending general anaesthetic surgery and in ordering an external review. It suggests that an internal review should first have been initiated to assess the extent of any problems with keyhole surgery and before any decision was taken to suspend operations.
The health executive said today the review found room for improvement in surgery record-keeping and communication.
The review also highlighted the need for more robust arrangements to obtain and record informed consent from patients.
The HSE says the review also suggests additional safeguards at local, regional and national level to ensure appropriate governance for the protection of patients and staff.
It says a clinical governance structure will need to be put in place prior to the reintroduction of surgery at Navan.
"A small, stand-alone surgical department is not viable in terms of expertise or clinical governance, and requires to be part of a larger surgical department," the HSE said.
The health executive acknowledged that any review process can cause distress to hospital staff and it was mindful that such a review process 'may lead to perceptions or reputational damage to staff.'
The HSE said it 'regretted in full' perceptions of reputational damage that may have arisen and stressed that the purpose of the review was to protect patients and ensure quality care.
"The decision to restrict surgical services at Navan Hospital was predicated solely on ensuring a safe service for patients. Surgical services have continued at Navan Hospital, albeit restricted pending the outcome of the review."
Following an initial decision to end keyhole surgery at Navan last August, which preceded the decision to further restict more surgery, the surgeons at the hospital told the HSE their clinical results for procedures compared favourably with all published figures.
They said at the time there had been one death recently relating to keyhole gallbladder surgery, but this had been in an elderly patient and was not directly related to the surgery.
One of the general surgeons at the hospital had previously been placed on administrative leave but was subsequently reinstated.
Prior to the suspension of a wide range of minor and intermediate surgery at Navan last year, no major surgery had been carried out there since 2006, although major orthopaedic surgery takes place there, as it is the regional orthopaedic unit for the north-east.
However, a range of minor and intermediate surgery procedures previously restricted at Navan may now be allowed to take place again.
The review report gives a list of operations that can in future be safely carried out under general anaesthetic at Navan. These include minor procedures, hernia operations, keyhole gallbladder operations, varicose vein procedures and proctology procedures.
The review was chaired by UK surgeon Mr JW Rodney Peyton.
Plans are still in place to end 24-hour emergency department care at Navan.
However, Health Minister James Reilly has said this this will not take place for at least six months.
|anony Posted: 27/07/2011 22:37|
It does not matter what the review shows - the services will go. They will reduce the level of surgery allowed, they will reduce the level of A & E presentations with ambulance protocols, they will reduce the workload in the hospital to such a point that they can claim that other services are unsafe or that the medics will become deskilled, that anaethetists are becoming deskilled and away goes the hospital.
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