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Postop outcomes have improved nationally, finds report

Length of stay shortened and complication rates fell in 2018-19 in 124 hospitals

Caroline White

Friday, 20 September 2019

Postoperative outcomes improved last year, with length of stay shortening and a fall in complication rates, finds the second annual report published by the academic research Perioperative Quality Improvement Programme (PQIP), which works on behalf of the Royal College of Anaesthetists among others.

Its 2018-19 report found that the care of, and outcomes for, surgical patients had improved. Using data from almost 20,000 people having operations across 124 hospitals, it found that major postoperative complications had fallen from 18.7% to 16.4% and length of hospital stay had shortened from 8.9 days to 7.8 days in one year.

If repeated across the NHS, this would lead to an annual saving of £346 million, based on the rate of 1 million procedures a year, and NHS Improvement‘s cost analysis of £346/day for the cost of a hospital bed, it says.

The report also found improvements in various processes aimed at returning patients to normal function as soon as possible after surgery: drinking, eating and getting moving.

But it acknowledges that there are still some “hard nuts to crack,” including anaemia management, individual risk assessment, diabetes care and acute pain management.

Accordingly, PQIP’s top five national improvement priorities for 2019-20 to improve the care of surgical patients before, during and after their procedures will be: preoperative assessment; diabetes management; communication and multidisciplinary working; individualised pain management; and enhanced recovery.

“Nationally around 1.5 million people undergo major surgery each year and 25% of the population have a long-term condition. The population is ageing with increasing numbers of comorbidities and associated frailty,” writes Professor Ramani Moonesinghe, PQIP chief investigator, in the report’s foreword.

“It is against this background that PQIP is carrying out its important work…Even though we are still very early in our collective improvement endeavours, major outcomes and some key process measures are improving and we have seen a drop in major postoperative morbidity and length of hospital stay,” she adds.

The way to make these improvements is to measure, report, and support local teams to act on their own quality data, she says.

“We know that making improvements happen takes time, effort and personnel. Teams that have huge enthusiasm for trying to make improvement happen, can lack time, resources or a supportive culture for delivering [quality improvement] projects.

“So this year we are launching a series of competitions aimed at promoting some local [quality improvement] activity and spreading stories of good news and success. We want to hear success stories about communication and engagement – this is at the centre of our realigned priorities for the coming year.”

The PQIP results had shown that this approach worked, she said, adding that she hoped more hospitals would contribute “so we can continue to drive further improvement in patient care”.

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