I've been percolating on this one for a week or so now, but want to share it with you all because I need some other opinion.
In a session on peri-operative care, one of the consultants said that it was no longer 'normal practice' to order a chest Xray prior to an operation. Previously, JHO's and Fy1's had always ordered one for the anaesthetist. However, since the Surgeon didn't need it, and the anaesthetist usually didn't need it, the reports attached to the Xray were not read, and on occasion, small tumours etc were missed, which were later investigated and the Radiologist report read "the mass seen on dd/mm/yyyy has enlarged". The family got upset that no one had read the report of the original mass, and sued the NHS.
The consultant then went on to say that we should also never order blood tests that we did not need for the current management of the patient, because if we found an adverse result we would have to act on it.
I guess this comes down to 2 main questions:
a) should NHS hospitals be screening people for common ailments just because they have been admitted with a different condition.
b) if a hospital finds an adverse result and commences management as an in-patient, does the hospital pay instead of the PCT.......
Some patients do seem to fall through. we saw a lady with gallstones who had an irregularly irregular pulse. to us Med students that indicates AF. Yet despite having her pulse taken every 4hours, no one had noted the rhythm/character or done an ECG (she was admitted via GP not via A&E). She was due an operation at the tail end of last week, so it will be interesting to see if she received an ECG / cardiology referral, or if the anaesthetist was the first to notice in theatre! If so, might it be the downside of the assertion that investigations should not be carried out unless necessary. no-one thought it necessary, and they have to deal with the result.
Similarly, we saw a patient on an orthopaedic ward who had a BP of 180/100mmHg, despite being on triple therapy for Hypertension (Angiotensin 2 receptor antagonist, Calcium channel blocker and ACE inhibitor), and despite an inpatient stay of 2 weeks, had not had a review done by anyone from the Medical side of the hospital.
Conversely some departments are very good. Especially those with links. Vascular wards are quite good for getting cardiology to come and check out patients who display any cardiac signs - many get ambulatory ECG or 24hr recording monitoring to establish the nature of any cardiac complaint. But again vascular and cardiology are very closely linked physiologically and pathologically.