Posted: 06/02/2023
Following on from the last article in this surgical series, which discussed the ‘safety netting’ advice that is given to patients on their discharge home following surgery, this article considers the management of patients in hospital following surgery.
The length of time that a patient will need to stay in hospital following surgery is usually anticipated in advance. A plan may be in place for there to be a necessary period of intensive care following surgery (for example, with cardiac surgery). For more routine surgery, the patient will return to the ward, for a planned period of recovery.
Complications following surgery can develop during this period. Sometimes the patient will be on a surgical ward, but this may not always be the case, and it can be more difficult for those treating the patient to assess their needs, and for the relevant and necessary surgical input to be available if required.
Individuals who have had surgery, whether planned or as an emergency, will be familiar with the regular review by nurses and healthcare assistants in taking their ‘vital signs’. While this can be a disruption to a peaceful rest after surgery, it is a necessary and key tool that is used to monitor the post-operative patient. The vital signs that are usually assessed include:
It should be noted that the type of assessment may depend upon the surgery that has been carried out, the particular risks of that surgery, and the characteristics of the patient.
These measurements provide a key and early understanding of how the patient is recovering from surgery, as well as warning of any potential concerns. The National Early Warning Score (NEWS) 2 was introduced by the Royal College of Physicians originally in 2012, updated in December 2017, and is due to be reviewed this year. It is a system to standardise the assessment and response to acute illness, and is intended to improve the detection and response to clinical deterioration in adult patients. It is a key element of patient safety and improving patient outcomes.
As each of the above parameters are recorded, they are allocated a score, with the magnitude of the score reflecting how far the parameter varies from the norm. A calculation is then carried out, which gives the resulting NEWS score, and this score is recorded.
These scores then correlate to the level of clinical risk and the response required:
[Reproduced from: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.]
Problems can occur in patient records in respect of the use of NEWS scores, when the following happen:
The use of NEWS scoring can also give sometimes falsely reassuring assessments. The patient may be complaining of symptoms such as increased pain or deferred pain, but have an otherwise ‘normal’ NEWS score.
It is important for the individual to be assessed and for their voice to be heard. Patients often feel vulnerable following surgery and, particularly through the pandemic with restricted or limited visiting, patients have been less able to advocate for themselves and to explain their symptoms and concerns.
Penningtons Manches Cooper has a specialist team of surgical negligence solicitors who deal with the full spectrum of surgery related medical negligence claims. If you think you may have a surgical claim, even if the type of claim has not been mentioned above, please do not hesitate to get in touch with a member of the team for an initial discussion.
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