New report into Acute Small Bowel Obstruction

NCEPOD (The National Confidential Enquiry into Patient Outcome & Death) review clinical practice and identify possibly improvements in treatment and patient care. They have reviewed the clinical care of patients admitted to hospital with acute bowel obstruction so they can learn about the provision of current treatment and provide guidance with respect to improving care where needed, and the report was recently published.

The study has highlighted significant opportunities to improve care for people admitted to hospital with acute bowel obstruction and the main findings were as follows:

“There were delays in scans in approximately one in five* of the cases reviewed and the delays increased if an abdominal X-ray was performed as well as an abdominal CT scan. Furthermore, a delay in imaging led to a delay in diagnosis in six out of ten of patients whereas only six out of one hundred patients had a delay in diagnosis if there was no delay in imaging.” NCEPOD 2020

“Delays in consultant assessment led to a delay in diagnosis in 4 out of ten patients. Only 16 out of 100 patients who were seen in a timely manner by a consultant experienced a delay in diagnosis. Following diagnosis one in five patients experienced a delay in access to surgery and in half of patients the delay was due to non-availability of theatre and in 47 out of 100 it was due non-availability of an anaesthetist.” NCEPOD 2020

“To prevent malnutrition and acute kidney injury, nutrition and hydration status are fundamental to care in patients with an acute bowel obstruction, these were often not well assessed. Only 24 out of 100 patients had their hydration status recorded, 41 in 100 patients either had no nutritional status assessment or the assessment was inadequate and only 38 in 100 patients had a nutrition assessment on discharge.” NCEPOD 2020

NCEPOD have therefore made some recommendations as follows:

• Undertake a CT scan promptly.
• A consultant review should be completed within 14 hours of admission or if high risk (see guidelines) discussion is advised with a consultant within an hour.
• Patients admitted to hospital with a diagnosis of acute bowel obstruction should be admitted under the surgical team.
• Assess pain in patients with acute bowel obstruction and provide pain relief within local and national guidelines.
• Measure and document hydration status at admission to hospital and throughout admission.
• Undertake and act on nutritional screening using the MUST tool and continue to screen weekly and refer to a Dietitian or the hospital nutrition team when diagnosed. Screen prior to discharge.

*Please note figures published here are approximate to help readability – please see the final report for accurate percentages