Freedom of Information Request: 0131 2019/20
University Hospitals Birmingham NHS Foundation Trust (UHB) completed a merger by acquisition of Heart of England NHS Foundation Trust (HEFT) on 1st April 2018. Due to historical differences in data collection/reporting across UHB and the former Heart of England NHS Foundation Trust this response has been provided by hospital site.
Following procedures set out on your website, I am writing under the Freedom of Information Act 2000 and/or the Environmental Information Regulations 2004 for the following information on each Hospital under your Health Trust:
It is likely that the Trust does hold all the information you have requested however we are withholding this information for the reasons given below.
The information you have requested relating to incident and mortality rates for acute bowel ischemia is not held centrally. We estimate that to retrieve this information by going through approximately 910 individual patient records (at 5 minutes per record this would take in excess of 18 hours). For this reason, we are withholding some of the information you have requested, under Section 12.
Section 12 of FOIA allows a public authority to refuse to deal with a request where it estimates that it would exceed the appropriate limit, which is currently £600 for central government and £450 for all other public authorities.
- Various incident and mortality rates for acute bowel ischemia for each year over the period 2007 – 2018 (the table to be completed is attached). Please see the attached spreadsheet – please be aware that we have provided the information that is available to us, the rest is being withheld under S12 – please see above explanation for ‘S12’ cells in the spreadsheet.
- An explanation of how the rates have been calculated. The information has been provided by the Informatics department, who utilised the coding of certain conditions to pull data from the system.
- Details of the formal processes, procedures, pathways and other means of diagnosing acute bowel ischemia used by the hospital and its health professionals (including but not limited to those used by the surgical team, nurses, radiologists, intensive care)?
- Details of any informal processes, procedures, pathways and other means of diagnosing acute bowel ischemia used by the hospital and its health professionals (including but not limited to those used by the surgical team, nurses, radiologists, intensive care)?
Answer to Q3 & 4 for UHB: There are no documented pathways. Patients are diagnosed by taking a careful history and performing a careful examination. Bloods tests can be helpful if the WCC is very raised of if the patient is acidotic on a blood gas but bowel ischaemia can occur in the absence of abnormal blood tests. It is largely a clinical diagnosis. Once suspected a CT scan is normally performed which can be helpful but which again can be falsely reassuring. The urgency of investigations depends largely on the patients clinical condition.
Once a diagnosis of ischaemic bowel has been made, patients would be treated by continuing nil by mouth and IV fluids. IV antibiotics would frequently be given to treat translocation of bacteria. The decision to operate is largely on clinical grounds but if the CT shows definite signs of ischaemia such as gas in the bowel wall, we would normally proceed on an urgent basis to laparotomy and bowel resection. Frequently this is “damage control surgery” where the effected bowel is removed and the patient planned to return to theatre in 24 to 48 hours to confirm there is no further ischaemic areas and to decide whether to join the bowel or bring out an ileostomy.
Acute bowel ischaemia is the final stage of a number of pathological processes whereby the vascular supply to the bowel is compromised and a patient presents with acute abdominal pain and eventually peritonitis. The diagnosis is made by the usual process of history and examination with investigations. Diagnosis of the problem at an early stage of the pathological process requires a high degree of clinical suspicion but this is rare.
The information should be provided for each hospital rather than for the Trust.
