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Delay in Transit: selected recommendations from the NCEPOD report on acute bowel obstruction
  1. Martin Sinclair1,
  2. Alison Culkin2,
  3. Andrew C Douds3,4,
  4. Antony Michalski1,
  5. Hannah Shotton1
  1. 1 The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), London, UK
  2. 2 Nutrition & Dietetic Department, St Mark's Hospital and Academic Institute, Harrow, London, UK
  3. 3 Gastroenterology, Queen Elizabeth Hospital Kings Lynn, Kings Lynn, Norfolk, UK
  4. 4 University of East Anglia, Norwich, Norfolk, UK
  1. Correspondence to Dr Hannah Shotton, NCEPOD, London EC1M 4DZ, UK; HShotton{at}


Delayed in Transit, the report of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) on acute bowel obstruction (ABO), highlighted a number of areas for improvement in this group of patients. The overarching finding was that there were delays in the pathway of care for patients with ABO at every stage of the clinical pathway, including diagnosis, decision-making and the availability of operating theatres. Furthermore, basic measures including hydration, nutritional screening and nutritional assessment were noted to be deficient. Patients who were admitted to non-surgical wards had an increased risk of delayed treatment and subsequently a longer starvation period. There was room for improvement of nutritional screening and assessment on admission, throughout the hospital stay and on discharge. A selection of the report recommendations that address these areas requiring improvement is discussed here.

  • abdominal surgery
  • colorectal surgery
  • nutritional status

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  • Contributors AC was part of the Study Advisory Group who helped design the study. MS and AM were clinical coordinators leading the study and HS oversaw the data collection. ACD was one of the case reviewers, contributing to data collection for the study. HS carried out the data analysis, and MS and AM wrote the resulting NCEPOD report. MS planned the article and contributed it. AM contributed to, reviewed and edited the article. AC and ACD contributed to and reviewed the article. HS contributed to, reviewed, edited and submitted the article.

  • Funding The NCEPOD review of acute bowel obstruction was commissioned by The Health Quality Improvement Partnership (HQIP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations, and crown dependencies (

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.