Title: Enhancing the safety quality and productivity of perioperative care
Funder: Department of Health (England)

Abstract: Background:Darzi’s report High Quality Care for All: NHS Next Stage Review (2008) placed quality and safety of care at centre stage for the NHS and its users. This is echoed in the key components of the DH document NHS 2010-15: from Good to Great.This proposal will address four of these: quality safety access and improved care in long-term conditions.An estimated one million people undergo surgery in the UK each year. Safety is vital; unintended adverse events are estimated to cost the NHS up to £400 000 per Trust per year through increased costs length of stay and litigation (National Audit Office: A Safer Place for Patients 2005). Organisational efficiency in the operating theatre is key to income generation from elective surgery and impacts on targets relating to cancer treatment time spent in Accident and Emergency and non-clinical cancellation of surgery. Anaesthesia is a safety-conscious specialty and this bid if successful would be part of the NIHR-funded Lancaster Patient Safety Research Unit. It is also the largest single hospital specialty and is involved in the care of up to two-thirds of inpatients at some stage of their stay. Hence findings from within the specialty will influence practice across a range of acute specialties.Theme and scope of proposed programme (1000 characters max):The theme of the programme is the quality safety and productivity of perioperative care. New reviewsSafety: e.g. perioperative monitoring Quality: perioperative management of high-risk patients focusing on obesity the elderly and people with diabetes mellitusProductivity: e.g. theatre list scheduling and utilisation and enhanced postoperative recovery programmesAs some of the topics are complicated and involve more complex interventions we propose to do 16 new reviews.UpdatesUpdate/adaptation work (we propose 20 such reviews) will take place in 3 streams:a. existing work on the relative safety and effectiveness of different anaesthesia providers (e.g. physician vs. nurse) b. reviews performed to support the NICE guidance on the management of perioperative hypothermia..c. ‘orphan’ protocols and reviews that need updating within the Cochrane Anaesthesia Review Group – these are listed below with the relevant CARG review number. Within both new and updated reviews we will focus where possible on outcomes of greatest relevance to patients for instance sore throat postoperative nausea and vomiting hypothermia infection length of stay etc. ___________________________________________________________________________Proposed reviews to be undertaken and/or updated and how the choice is justified in terms of NHS priorities (2000 characters max):New reviews (16)SafetyPerioperative temperature monitoring for prevention of postoperative hypothermiaIntraoperative non-invasive cardiac output monitoring for prevention of postoperative complicationsMedication safety in the perioperative periodPerioperative critical incident reporting and its effect on safetyQuality of care for high-risk patientsEndotracheal intubation vs. laryngeal mask airway in obese patientsConventional vs. fibreoptic intubation in obese patientsNasal vs. oral fibreoptic intubation in obese patientsPerioperative glycaemic control in adults with diabetes mellitus undergoing surgeryAnaesthetic techniques for the frail elderly undergoing minor surgeryAnaesthetic techniques for the frail elderly undergoing major surgeryAwake vs. anaesthetised fibreoptic intubation and patient outcome in high-risk patientsProductivity/qualityQuality and safety indicators in anaesthetic practicePreoperative assessment of the surgical patient: physician vs. nurse-led assessmentStrategies for efficient use of operating theatre time (2 reviews)Enhanced postoperative recovery in patients undergoing elective abdominal surgeryUpdates/conversions (20)Conversion of protocol to reviewEnteral nutritional supplementation with arginine for critically ill patients (CARG 039)Colloid vs. crystalloid solutions for priming cardiopulmonary bypass circuits (CARG 049)Reviews for updatingPatient-controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery (CARG 011)Central venous access sites for the prevention of venous thrombosis stenosis and infection in patients requiring long-term intravenous therapy (CARG 021)Early extubation for adult cardiac surgical patients (CARG 033)Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery (CARG 067)Conversion of non-Cochrane to (updated) Cochrane reviewsSafety and effectiveness of different anaesthetic providersPrevention and treatment of perioperative hypothermia. We will be able to produce 12 reviews in this field by working with the group that produced the NICE Perioperative Hypothermia guideline to update the reviews in that guideline as Cochrane reviews ready for the guideline revision in 2011. _______________________________________________________________________Outline plan and timetable for undertaking reviews including how award would be used (eg. employment of new researchers) (2000 characters max):We envisage that the outputs of the programme will appear in two broad tranches. In the first 18 months of the award we expect to produce a number of updates and also convert the NICE hypothermia reviews into Cochrane format. The new reviews will begin to appear towards the end of this period but most will be finished during the second 18 months of the programme. We will employ two new researchers a full-time senior experienced Cochrane reviewer and 0.5 WTE junior researcher to assist. We will also be able to draw on existing staff from within the Lancaster Patient Safety Research Unit and a Clinical Fellow in Anaesthesia funded by UHMB and the North West Deanery currently being advertised to start in August 2010. Each review will be assigned a ‘clinical mentor’ from within the clinical staff of the Department of Anaesthesia or a relevant surgical specialty from within UHMB or allocated from the expert panel of the National Institute for Academic Anaesthesia Research Council. Patient representation will be part of each review both through the usual Cochrane consumer review process and where necessary and appropriate from additional local or national sources.


Research activity codes: 6.4 SURGERY
Health categories: GENERIC HEALTH RELEVANCE