Clinical audit
Alerting hospitals to problems early Hospitals are encouraged to capture data through the web tool as patients progress through the pathway – at pre-op, during the operation, at post-op stages and at discharge. “If it is live, each site can see in real-time what is happening to this patient cohort,” says Lourtie. This also means that problems can more easily be highlighted early to minimise impact on patients. “We flag when organisations need to improve,” he explains. “We provide them with quarterly reports, so they can see if there is an issue, and we have implemented a reporting mechanism, so that if metrics fall below a threshold, they trigger an unofficial alert to the organisation’s lead, for them to act on quality improvement. “Sites can then do their analysis and change
processes. We, as a Royal College, can make recommendations, but it is for the hospitals to implement change.”
An audit technology partner Having an effective technology partner has proven to be an important part of the audit’s success, Lourtie explains. “The team came with expertise in building audits, and that has meant that those inputting the data have found it simple and easy to use,” he comments. “We have been working with the experts in creating tools to collect data at a national level, who know how to make that work within the NHS, which can be a difficult environment to operate from an IT perspective.”
PQIP, NAP and SNAPs – other projects The Royal College has continued to engage with the team behind CaseCapture on a wide
range of other important audit projects, all designed to help improve standards in care. This includes the Perioperative Quality Improvement Programme (PQIP), which is used to understand complications, mortality and patient reported outcomes associated with millions of operations carried out in the NHS each year. The audit is not mandatory, but approximately 140 hospitals participated at the time of the most recent report. “This has allowed us to create improvement tools and to outline priorities nationally and for
each site locally,” says Lourtie. Focused on major non-cardiac surgery, the
audit was first established in 2016 and continues to inform healthcare providers with important information on what happens to patients undergoing procedures, as well as providing insights on complication rates, and patient recovery.
Importantly, it has been supporting the implementation of best practice, collecting data from the perioperative environment and from a wide multidisciplinary workforce that includes
National Emergency Laparotomy Audit findings for 2023
Based on data from 22,132 patients who had emergency bowel surgery in England and Wales between December 2020 and November 2021, the most recent report from the National Emergency Laparotomy Audit (NELA) found that improvements in in-hospital mortality have levelled off (9.2% in year 8 compared to 9.1% and 9.6% in years 7 and 6 respectively). As such, it calls for hospitals to continue to engage with NELA data collection and, in particular, to make use of real-time data and resources available to drive clinical and service quality improvement. In addition, the report found that there
has been improvement in various aspects of care around emergency laparotomy, such as direct consultant delivered care in theatre and length of postoperative hospital stay. It states that specific concerns remain around delays in pathways of care for many patients between time of arrival in hospital and definitive surgical intervention (‘door-to-surgery time’). More specific key messages include: l Patients experienced long delays from time of arrival at hospital to time of surgery, including those with sepsis suspected at arrival in hospital (median 15.6 hours to theatre)
l Many patients (77.7%) with suspected sepsis on arrival did not receive antibiotics within an hour of arrival in hospital
l One in five high-risk patients did not receive postoperative care in a critical care unit.
The report also found that frailty doubled the risk of mortality of patients aged 65 and over (13.0% vs 5.9%), but review by a member of the elderly care team was associated with a significant reduction in mortality (5.9% vs 9.5% among non-frail patients, and 13.0% vs 22.3% among frail patients). However, this is not routine practice in many hospitals.
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