Central London Patient Safety Research Collaboration

Study Overview
=================
Brief Summary
-----------------
Patient safety is a priority for healthcare systems. In safe systems, patients would be saved from avoidable harm, both from their own conditions, and from the care and treatments provided to them. Amongst the highest risk clinical settings are Surgical, Perioperative, Acute and Critical carE services (SPACE). The Central London Patient Safety Research Collaborative is funded to deliver world-class research into improving the safety of SPACE services, within which the investigators will evaluate major service reorganisation, compare and investigate organisational safety and quality, and investigate the disparity in postoperative complications associated with socioeconomic factors.

Detailed Description
-----------------
Patient safety is a priority for healthcare systems. In safe systems, patients would be saved from avoidable harm, both from their own conditions, and from the care and treatments provided to them. International estimates suggest that of 421 million hospitalisations worldwide annually, there are 42.7 million adverse events or unsafe experiences, making avoidable harm the 14th leading cause of death and serious illness. Amongst the highest risk clinical settings are Surgical, Perioperative, Acute and Critical carE services (SPACE), treating >25 million NHS patients annually. Patient safety risks are particularly likely in these environments, both because of what clinicians are required to do (the trauma of surgery and anaesthesia, the need for rapid recognition and decision-making in acute illness) and the patient's condition (because acute illness and surgery compound the risks from long-term conditions such as diabetes and heart disease). The Central London Patient Safety Research Collaborative will be funded by the NIHR to deliver world-class research into improving the safety of Surgical, Perioperative, Acute and Critical carE services (SPACE) services. Three themes, using existing patient data, are included in this application: Safer services The investigators will evaluate the safety of SPACE-related interventions of the NHS' post-pandemic Elective Recovery Plan. The investigators will use NHS administrative datasets to identify and explore changes in safety and quality over the implementation timeframe using advanced statistical methods. Safer organisations From linked clinical and administrative datasets, The investigators will identify and seek to contextualise high- and low-performing units and hospitals across SPACE services using advanced statistical methods. This work will be followed by qualitative research, exploring why differences exist. Safer innovations The investigators will identify the timeframe over which patients from deprived backgrounds develop worse postoperative outcomes (as has previously been demonstrated). These novel findings could pave the way for interventions to reduce inequality.

Official Title
-----------------
Safer Services, Organisations, and Innovation: The Central London Patient Safety Research Collaboration

Conditions
-----------------
Surgery-Complications, Safety Issues

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: as determined by clinical audits Exclusion Criteria: missing key data items/ or linkage

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Before major system reorganisation<br>Theme 1 - elective recovery plan 2017/18-2019/20 | |
| Before major system reorganisation - intra-pandemic<br>Theme 1 - elective recovery plan 2020/21-2021/22 | |
| Post system reorganisation<br>Theme 1 - elective recovery plan 2023/24 and 2024/25 | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total number of elective operations performed within the NHS | Process and outcomes following major system change (Theme 1): To be presented and analysed nationally, regionally and at hospital Trust- level To assess the effectiveness of the NHS Elective recovery plan (https://www.england.nhs.uk/2022/02/nhs-publishes-electives-recovery-plan-to-boost-capacity-and-give-power-to-patients/) | 8 years (2017/18 - 2024/25) as per cohort definitions | 
| Incidence/prevalence of postoperative complications | Process and outcomes following major system change (Theme 1): Postoperative complications. Occurring whilst inpatient, following the index surgical procedure. Classified using the Clavien-Dindo and Postoperative Morbidity Survey systems We will gather and link data from national audit and registry datasets. We will compare patient outcomes within and between organisations to investigate safety and quality | Pre 2023 | 
| Incidence/prevalence of postoperative complications stratified by socioeconomic and ethnic descriptors | Theme 3 safer innovations: Postoperative complications. Occurring whilst inpatient, following the index surgical procedure. Classified using the Clavien-Dindo and Postoperative Morbidity Survey systems We will gather and link data from national audit and registry datasets. We will investigate divergences in patient outcomes, stratified by socioeconomic and ethnic descriptors | Pre 2023 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean/median postoperative length of stay (days) | Theme 1: Health economic assessment of the implementation of the NHS Elective recovery plan | 8 years (2017/18 - 2024/25) as per cohort definitions | 
| Mean/Median postoperative critical care length of stay (days) | Theme 1: Health economic assessment of the implementation of the NHS Elective recovery plan | 8 years (2017/18 - 2024/25) as per cohort definitions |