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The hospital with some of the highest death rates among patients with heart problems in the United Kingdom has been ordered to improve poor team working and lack of quality checks.
The NHS standards watchdog, the Healthcare Commission, published the findings of its investigation into the Oxford Radcliffe Hospitals NHS Trust and said that mortality for heart surgery was within acceptable limits.
But the commission said that the trust's cardiothoracic surgical unit lacked key components of a high quality service and needed to improve.
The investigation was prompted by concern over higher than expected mortality and a history of problems in the unit since the late 1990s.
These included a critical report by the NHS Executive in 2000, and the trust was the only one to receive a band one rating—significantly below average—for the Healthcare Commission 2004-5 clinical indicator for the number of deaths within 30 days of a coronary artery bypass graft.
The number of patients who died between April 2002 and March 2005 after their first coronary artery bypass graft at the trust was more than double the national average—4.01% compared with 1.83%.
The commission's report criticises the trust for failing to review its performance despite being aware that its mortality for the most common cardiac operation was greater than average. In addition, the trust did not tailor its systems to patients at high risk.
The report says, “The consultant surgeons lacked the willingness to work together to develop the service or to critically appraise the care given to their patients.”
The report makes 13 recommendations relating to consent by patients, management of patients assessed as at high risk, clinical governance and leadership, and collection and use of data.
Anna Walker, chief executive of the commission, said, “This investigation has shown that this unit is currently operating within acceptable limits. Patients should be reassured by that.
“But the investigation also shows that surgeons must analyse the causes of high mortality when it occurs; ensure that arrangements for proper care are in place for high risk cases; and work closely together and with colleagues in other specialties. The Oxford Radcliffe needs to do this systematically.”
Trevor Campbell Davis, the trust's chief executive, said that many of the recommendations were already being acted upon. He added, “This report shows that adult cardiac surgery in Oxford is safe. It confirms the cardiac surgeons operate on some of the sickest patients in the country and that their results following coronary artery bypass grafts are within the expected range.”
Peter Weissberg, medical director of the British Heart Foundation, said, “The extreme demands and individual responsibility of life saving surgery suit strong minded individuals to whom team working doesn't always come naturally.
“However, in a modern health service team working and strong leadership is essential. Workload must be distributed according to skill, and lessons from individual mistakes must be learned by all.”
The report, Investigation into Cardiothoracic Surgical Services at the Oxford Radcliffe Hospitals NHS Trust, is available at www.healthcarecommission.org.uk.