The quality improvement in emergency surgery shows no difference in the patient's survival

Researchers at Queen Mary University in London investigated the effectiveness of one of the largest national quality improvement programs of the National Health Service (NHS) and found no improvement in the survival of patients. patients.

The overall risk of death after a hospital operation within the NHS is one in 65. However, one in ten patients undergoing emergency bowel surgery dies within 30 days.

The effectiveness of a national quality improvement program aimed at improving survival after an emergency abdominal surgery trial (EPOCH), funded by the National Research Institute in health and published in The Lancet, tested the effectiveness of a national program of quality improvement in 93 NHS Hospitals.

The trial involved patients aged 40 years and older who underwent major bowel surgery. Data were badyzed for 15,856 patients to determine whether hospital staff could improve their survival by making significant improvements in the quality of care. 37 qualitative improvements were made, including greater involvement of experienced physicians (consultants) in decision making, better risk badessment of the patient before and after surgery, presence of the consultant during surgery, and critical admission after the surgery. surgery.

The researchers found that such significant changes were too difficult to implement over a short period of time. The 90-day mortality rate was 16% in the usual care group and in the quality improvement groups, which means that the team found no benefit from the program in terms of survival.

Lead author Rupert Pearse, a professor and consultant in intensive care medicine at Queen Mary University in London, said: "The main message of this essay is that it is much more difficult to improve the quality of life courses. complex patient care Health leaders, such as experienced physicians and nurses, need more time and resources to improve patient care. "

Some health professionals have argued that quality improvement programs are ineffective. Despite this, health care policy encourages their widespread use to drive change on a large scale. The EPOCH trial findings suggest that this approach will only work if hospital leaders have the resources to make lasting changes.

Prior to the EPOCH trial, most experts thought that the lack of awareness of the number of deaths after emergency abdominal surgery was the main reason for poor patient care.

Professor Pearse said, "We now have a better understanding of the problem, clinicians were too busy with patient care and had no free time to improve it, and quality improvement programs are not a solution. quick and easy to improve NHS patient care – a more realistic approach to this work. "

The findings suggest that future quality improvement programs should implement fewer changes over a longer period and that the physicians and nurses responsible for these changes have sufficient time in their workday to improve care. to patients.

Professor Pearse added, "This essay tells us why our quality improvement did not work and what we need to do differently."

This learning has already been shared with teams from the National Audit of Ongoing Laparotomy (NELA, http://www.nela.org.uk) and the Collaborative Laparoscopy Project. Emergency laparotomy (ELC) organized through academic health science networks in England and Wales, by 2020.