Patients who require emergency oxygen treatment in hospital are dying unnecessarily because of the poor care they receive, with an NHS inquiry calling its own findings “shocking”.
One in three patients requiring emergency help with their breathing are dying, with staff and equipment shortages contributing to this poor outcome, the report revealed.
By contrast, only 18 per cent of patients receiving the treatment in Spain die each year while just ten per cent of French cases end in death.
The National Confidentiality Enquiry into Patient Outcome and Death examined the treatment the 50,000 patients who receive emergency oxygen treatment each year, uncovering a series of major problems.
Of particular concern was the number of patients who receive non-invasive intervention (NIV) oxygen through a face mask, with the vast majority of the 353 patients examined receiving sub-standard care.
NIV is most commonly used to help patients with chronic obstructive pulmonary disease (COPD) – the fifth biggest killer in the UK and the second most common reason for hospital admissions. It is also commonly given for pneumonia.
The report found “wide variation in both the organisation of acute NIV services and the clinical care provided” and that treatment was often delayed or given where it was inappropriate and palliative care would have been the better option – possibly prolonging the suffering of dying patients.
It added: “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.”
NIV was rated “good” in just 27 per cent of cases, adequate in 35 per cent, and as poor or unacceptable in 23 per cent of patients.
Nearly 40 per cent of hospitals reported occasions in the past year when they had more patients requiring NIV than their capacity to deliver it due to staff shortages.
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Dr Mark Juniper, who co-authored the report and is the NCEPOD’s lead clinical coordinator for medicine, told the Guardian: “This is a major problem which is resulting in unnecessary loss of life. Four out of five patients didn’t receive care that we as doctors would be happy to receive. That’s quite an indictment. That’s shocking because all these patients are at risk of dying.
“Lack of ventilators is a common problem, even though a basic machine costs about £1,000 to £2,000. When there are too many patients, some end up receiving other medical treatment that’s not as good as ventilation. That will give them a higher risk of dying.”
The report calls for hospitals to appoint “local champions” to challenge and examine the provision of acute NIV services in their hospitals and to help design the services. It also calls for a list of “competent staff” to be maintained and for better monitoring and recording of the practice.