CQC publishes review of children’s cardiac case notes at Bristol Royal Hospital for Children

The Care Quality Commission has published its findings from an expert review of case notes of children who had undergone heart surgery at Bristol Royal Hospital for Children.

The review, which is complementary to the Independent Review of Children’s Cardiac Care which is also published today, was set up by the Chief Inspector of Hospitals in response to concerns raised by a number of families about the care of their children after their cardiac surgery at the hospital.

CQC had agreed to review the hospital’s clinical outcomes with support from the National Institute for Cardiovascular Outcomes Research (NICOR), comparing survival rates for children undergoing heart surgery at all cardiac centres within the UK and Republic of Ireland.

At the same time, a panel of clinical experts looked in depth at the care received by a number of children who had heart surgery in Bristol in the three-year period between January 2012 and December 2014.

The concerns were first raised in 2012 by two families whose children had been patients at the children’s hospital. After an unannounced inspection, CQC issued a Warning Notice to University Hospitals Bristol NHS Foundation Trust because inspectors found that there were not enough nursing staff to meet the needs of children who needed high dependency care on Ward 32, a specialist children’s cardiac ward. Subsequently the trust opened a dedicated high dependency unit. During a comprehensive inspection in September 2014, children’s services were rated Good overall.

The report that CQC has published today is based on the findings of a panel which included cardiac and children's specialists. They examined case notes for any evidence of systematic problems with the care that was provided during admission, diagnosis, preparation for surgery, the operation, post-operative care, and discharge from hospital.

The panel found that the standard of care provided was comparable with other centres in the UK. They did not identify any case where the standard of care fell below the expected level.

The report notes that the quality of the care reflected in the case notes improved after the hospital opened children’s high dependency beds following the inspection in 2012. The case notes found evidence of better bereavement support for families in later cases, including some excellent practice.

The National Institute for Cardiovascular Outcomes Research has reported that the 30-day survival for all heart surgery procedures at Bristol was comparable with all 14 children’s specialist cardiac centres during the three-year period 2012 to 2015. A study published in the journal Open Heart in 2015 concluded that UK survival rates compared favourably with international data. While the number of procedures performed nationally in the UK has increased over the last decade, the 30-day mortality rates for paediatric cardiac surgery have fallen.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said: “Our review looked closely at case notes which recorded the progress of children through all stages of their treatment, from admission to discharge. We included children whose operations were successful, and sadly also those who died shortly afterwards. My sympathies lie with those families, and all who have raised their concerns.

“Four years ago we were concerned that there were not enough staff available to care for those children who were recovering from cardiac surgery. Nurses and doctors told us that sometimes they did not have enough time to devote to the families when they needed their support. In time the trust opened a dedicated high dependency unit – and the evidence we have seen suggests that made a notable difference.

“It is significant that the latest data on children’s heart surgery shows that survival rates in Bristol are as we'd expect when compared with all the other specialist heart units in this country. The cases we reviewed indicated that some very difficult clinical problems were managed well and overall the reviewers had no significant criticisms of any individual child’s care.

“Although the panel noted several examples of good practice, we have made recommendations for improvements in some areas – notably in communication with children and their parents before and after surgery. It is important to ensure that when they are asked to give consent, families have the best possible information including a clear understanding of all the risks involved, even in the most difficult and sometimes distressing times.”

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