Researchers at Queen Mary University in London studied the effectiveness of one of the nation's largest national quality improvement programs in the National Health Service (NHS) and found no improvement in patient survival.
The overall risk of death after surgery at a hospital within the NHS is one in 65. However, one in ten patients who undergo surgical intervention in the intestines are dying within 30 days.
The effectiveness of the National Quality Improvement Program for Improving Survival after the Emergency Abdominal Surgery (EPOCH) trial, funded by the National Institute of Health Research (NIHR) and published in The Lancet, tested the effectiveness of the national quality improvement program in 93 NHS hospitals.
The trial involved patients aged 40 years or older who underwent surgery of large intestines. The data were analyzed for 15,856 patients to test whether hospital staff could improve survival with major improvements in the quality of patient care. There were 37 quality improvements, involving greater involvement of senior doctors (consultants) in decision-making, better patient risk assessment before and after surgery, the presence of a consultant during surgery, and critical admission following surgery.
The researchers found that such extensive changes were too difficult to implement in a short period of time. The 90-day death rate was 16 per cent in the normal care group and in quality improvement groups, which means the team did not find the benefit of surviving the program.
Senior author Rupert Pearce, a professor and intensive care consultant at Queen Mary University in London, said: "The main message of this study is that improving the quality of complex patient care pathways is much more difficult than we expected. and nurses need more dedicated time and resources to improve patient care. "
Some health professionals argue that quality improvement programs are ineffective. Nevertheless, health care policy promotes their widespread use to convey major changes. Findings from the EPOCH trial suggest that this approach will not work unless hospital leaders have the resources to make ongoing changes.
Before the EPOCH trial, most experts believed that a low awareness of the number of deaths following the surgery of emergency abdominal surgery was the main cause of poor patient care.
Professor Pierce said: "We now understand the problem better. Clinicians were too busy delivering patient care and there was no spare time to improve it. Quality improvement programs are not a quick or easy solution to improving patient care in the NHS. a more realistic approach to this work ".
The results suggest that future quality improvement programs need to implement fewer changes over an extended period of time and ensure that doctors and nurses leading to these changes have enough time to make improvements in patient care on their workday.
Professor Pierce added: "This trial tells us why our quality improvement does not work and what we need to do differently."
This learning has already been shared with teams from the current National Emergency Laparotomy Audit (NELA, http://www.nela.org.uk) and the Emergency Laparotomy Collaborative Project (ELC) project, which extends through the academic science networks of England (AHSNs) and in Wales, between now and 2020.
The researcher examines the impact of efforts to improve quality in Canadian hospitals
Carroll J. Peden et al., Effectiveness of the National Quality Improvement Program to Improve Survival by Emergency Abdominal Surgery (EPOCH): randomized clinical trials, Lancet (2019). DOI: 10.1016 / S0140-6736 (18) 32521-2
Improving quality in surgical intervention shows no difference in patient survival (2019, April 26)
taken on April 26, 2019
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