Royal Surrey awarded best performing Trust in study to help gall bladder patients | News

A Royal College of Surgeons (RCS) study has recognised Royal Surrey NHS Foundation Trust as the best performing Trust among 25 other UK centres for its treatment of patients suffering from acute gall bladder problems and for having the shortest wait times for patients from diagnosis to surgery at just under three days.

Gall bladder diseases can be very painful, severely affecting patients’ quality of life and they make up about one third of the UK’s emergency general surgery admissions.

Patients with gall bladder complications often face repeat visits to Accident and Emergency (A&E) departments, but prior to the RCS study, only 15 per cent of patients in England and Wales had surgery to treat the problem within the recommended eight days of being admitted to hospital.
 
To tackle this, and improve treatment across the country, the RCS set up a national Quality Improvement study. The pilot phase showed both improved patient outcomes and potential savings for the NHS of around £38,000 a year per patient.

Within 17 months of joining the study, Royal Surrey Hepatobiliary Team had introduced a new treatment pathway and involved surgeons from general surgical teams to take part and lend their help. The change meant that all gall bladder patients admitted to hospital were offered a cholecystectomy (operation to remove the gall bladder) within the recommended eight days of their admission. (The gall bladder stores small amounts of bile, which helps digest food in the gut, but it’s not essential for this process as bile is also made in the liver.)

Tim Pencavel, Consultant Surgeon at Royal Surrey, explained: “Gall bladder problems can cause severe, potentially life-threatening complications, such as pancreatitis, and these patients need to stay in hospital for months and months. 

“You can’t predict when a patient first presents whether they will be in the group that experience some pain and can go home and wait until their operation date, or if they’ll fall into the group who really struggle and face a life-changing complication.

“We recognised that by joining the RCS study there was an opportunity to improve treatment both for patients facing potentially life-threatening gall bladder complications and those who were waiting at home for an operation, experiencing recurrent pain and discomfort.” 

At the starting point of joining the study in July 2019, Royal Surrey was treating 20 per cent of gall bladder patients within eight days of their first admission, compared to the national figure of 15 per cent.

Tim explained: “Although we were ahead of the national figure when we joined the RCS study, we knew there was scope for improvement within the Trust. We had good support from our team of surgeons and we worked closely with A&E and anaesthetic and theatre teams to explain the relevance and urgency of changing our approach.

“By the end of the 17-month-long study, 100 per cent of our patients were being offered surgery within the recommended eight days and the majority were being treated within less than three days.”

One patient who has benefited from the new approach to treating gall bladder patients is 39-year-old Clive Pearson who was admitted by ambulance with suspected gall stones. Clive is autistic and has speech and language difficulties. His mother and carer Pam said: “I knew that because Clive has a high pain threshold, the level of pain he was in was pointing to something severe, as was the case. The operation list was full on the Friday that Clive was first admitted, but surgery was able to go ahead just a few days later. We’re really grateful to the team for expediting this at the earliest opportunity for Clive.”

Royal Surrey’s Hepatobiliary Team will take a mentor role for the next phase of the RCS study and help other Trusts improve treatment for patients affected by gall bladder related diseases. 

Louise Stead, Royal Surrey’s Chief Executive said: “I’m extremely proud that the Trust has been recognised as the best overall performing trust in the RCS study and has been invited to take on the role of mentor for the next phase of the study.

“This Quality Improvement programme has been a resounding success for the Trust and an incredible achievement given the pressures of working during a pandemic. I’d like to thank all staff involved for their fantastic team approach to improving patient experience and outcomes.”