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Leading hospital suspends complex heart surgery to maintain patient safety

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3896 (Published 12 September 2018) Cite this as: BMJ 2018;362:k3896
  1. Declan C Murphy
  1. London

A leading London teaching hospital has suspended the most complex types of heart surgery to maintain patient safety.

Jacqueline Totterdell, chief executive of St George’s University Hospitals NHS Foundation Trust, said that the decision had been taken “to protect the long term future of our cardiac surgery service.”

A trust spokesperson said that the move was a result of “response to feedback from clinicians working in the service” and was “to allow the service to focus on making improvements.”

The cardiac surgery unit performs around 90 operations a month, and the trust expects 5-10% of these cases to be moved to other heart centres, although the trust did not provide details of which patients would be affected. No date has been agreed for the return of complex heart surgery to the trust.

The performance of the heart unit at St George’s has prompted concern for some years. The unit was issued with alerts over its higher than expected mortality rates in April 2017 and April 2018.1

In July this year a report by Mike Bewick, an independent health consultant, raised concerns about mortality rates in the heart surgery unit and an allegedly dysfunctional environment.2 Bewick reported an overall mortality of 3.2% at St George’s heart unit in 2014-17, greater than the UK average of 2.0% during 2013-16.[2]

He said that staff reported “a persistent toxic atmosphere and a ‘dark force’ in the unit.” They “believed poor performance was inevitable due to the pervading atmosphere” and reported that the surgical team was “dysfunctional both internally and externally.” Staff called for “new blood” to be appointed at the consultancy level.

After Bewick’s review the trust commissioned Julia Hollywood, a human resources consultant, to review whether surgeons at the unit could be trusted to deliver a safe and sustainable service, “in light of the concerns raised about an apparent breakdown in working relationships.”

Hollywood’s review has not yet been published, but two cardiac surgeons from the trust were suspended in August 2018, the trust said. On 4 September it also has asked the regulator, NHS Improvement, to oversee the trust’s plans for improving its heart surgery service.

Routine cardiac surgery and all inpatient and outpatient cardiology services—planned and emergency—will continue as normal at the unit, a spokesperson said.

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