Dear have very An kept

patients to be discharged early following surgery (2-3 days post op common practice when they are feeling well and it may be that an anastomotic problem can happen afier nationally) been discharged All patients are advised about anastomotic leak in the_ pre-operative they have consenting; (as was the in question, and as indicated on the consent procedures and during and verbal advice about what to do if are unwell following discharge. They receive form) given written information about the operation and potential complications before the procedures 28 take to action to "prevent future deaths". These Through this Regulation you see as in mechanisms which ensure to and at the of discharge That we put place document assessments have been made (e.g: control),and we confirm and advice provided as information sheets of this process follow up arrangements, to include direct contact within 48
b. As part Colo-Rectal Nurse specialist bringing the service these emergency hours, by a patients receive in-line with that already in place for those under-going colonic procedures on an elective scheduled basis. This being the case we will by (unless otherwise specified) the 6th ensure the following are in place check-list- (example enclosed). Consistent with normal current Pre-Discharge practice for patients undergoing day case surgery, a checklist will be completed on discharge of all patients from the Colo-Rectal Ward All other Surgical Wards in Glan Clwyd required to develop and in place appropriate check-lists by end July: Patients to be provided with clear information leaflet (by end July 2015) which will outline Symptoms and signs of concern Those which may occur , not of concern The direct dial contact numbers for the Ward in the event of concern The expectation where instructed by ward staff, patients return directly to the colo-rectal for assessment; initially by ward Nursing Staff, and being patient 'they require point prior pain key July put yet ward

thereafter by the surgical registrar communicating his her to the Consultant who performed the surgery & /or On-Call Care of these patients to align with that of planned surgery (start by the 6"h Patients required to report by telephone to ward daily until contact by Colo- Rectal Nurse Specialist Colo-Rectal Nurse specialist to contact within 48 or as soon as return to normal work after a week-end. Anastomotic breakdown a known complication, our team believe Mr: Wilson is to have been told who and when to contact with any concerns_ However, prompted to look more closely we have identified gaps in our processes and documentation which have made such beliefs difficult to confirm. Committing to these actions, though specific to emergency bowel resection, we note the wider lessons. hope through this letter you are re-assured, and trust you will contact me directly should you require anything further: