Care of 23 elderly patients who died ‘unsatisfactory’

THE care of 23 of 32 elderly patients who died after being assessed for a heart procedure was unsatisfactory, according to an expert group.

The Royal College of Physicians (RCP) was brought in by what was then Abertawe Bro Morgannwg University (ABMU) Health Board to review the clinical management of patients between January 2015 and November 2018.

All of them had a narrowed aortic valve and were waiting for or had been considered for a procedure known as a trans-catheter aortic valve implantation (Tavi), which is much less invasive than open heart surgery.

Concerns about a growing backlog of these cases at Swansea’s Morriston Hospital – and the welfare of patients awaiting the procedure – led to an internal health board review. This in turn prompted the external RCP review.

According to ABMU’s successor, Swansea Bay University Health Board – which covers Swansea and Neath Port Talbot but no longer Bridgend – the physician group said:

  • The care of 23 of the 32 patients who died was unsatisfactory
  • One case was judged to have room for improvement for clinical reasons
  • Two cases were deemed room for improvement for organisational reasons
  • Four cases were deemed room for improvement for both organisational and clinical reasons
  • One case was considered to represent good practice
  • For one case there was insufficient information available to reach a judgement

A report by the health board said: “For 23 out of the 32 cases, the reviewers concluded that, on the balance of probability, earlier intervention could have had an impact on the patient’s outcome and that there had been a breach in the duty of care to the patient.”

The report explained that around half of patients with a severe narrowed aortic valve die within one to two years.

Around 30% of patients who undergo the Tavi procedure, it said, still die after one year, meaning that early intervention was important but not always successful.

The health board said it began addressing the backlog and care management problems before contacting the RCP, and added the majority of the RCP’s subsequent recommendations had been implemented.

Health board chief executive Tracy Myhill said: “We apologise unreservedly to patients and their families affected by past delays in accessing the keyhole heart valve procedure known as Tavi, and the harm this has caused.

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“Waiting times for Tavi for some of our cardiac patients have been too long, and it is with profound regret that we acknowledge some patients passed away before we were in a position to offer them the procedure.”

As of last month there were 51 patients waiting for the Tavi procedure – one waiting for more than 26 weeks, and 36 waiting for 10 weeks or less.

Extra money and staff resources have been directed at Tavi cases, and it is expected that 100 procedures will take place every year at Morriston Hospital.

The health board has now asked the RCP to look into the cases of Tavi patients who died before and after the 2015 to 2018 review period, and any other cases which initially fell outside of its review scope. The next of kin of these 46 patients has been notified.

In addition, a panel convened by the RCP visited Morriston Hospital last July and also spoke to health board leaders. Its final report is expected soon.

Swansea Bay University Health Board medical director Richard Evans assured the public it took “immediate actions to reduce the waiting list” before calling in the RCP.

Dr Evans added: “We acted promptly on the advice given by them, and a range of robust actions are already in place.

“Improvements to the way the Tavi service is managed means we are now treating new patients much more quickly.”

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