Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Future Engineers Australia Management Project: Turning high school students into engineering entrepreneurs

There has been a strong move towards entrepreneurial education in high schools and at universities over the past few years. This has been echoed by a call from state governments around Australia to promote enterprise thinking and education in high schools. It also parallels the push within engineering to learn across the traditional boundaries , particularly between engineering and business. To meet this call, The Engineering Link Group (TELG) developed the Future Engineers Australia Management Project (FEAMP) in 2003. The project is based around Enterprise Education, and was inspired by the Smallpeice Year 12 Engineering Management course in the UK. The idea was to take high school students in years 11 and 12 and turn them into ‘engineering entrepreneurs’. This paper presents the design, development and evaluation of FEAMP as a five day residential course for year 11 and 12 students who want to learn more about being entrepreneurs and managers. It is a hands-on activity where the students invent, develop and sell an engineering concept to venture capitalists and ultimately to customers at a trade fair. It has been run successfully for two years, going from strength to strength. © 2005, Australasian Association for Engineering Educatio

The engineering link project: Learning about engineering by becoming an engineer

There has been a greater emphasis over the past few years of encouraging high school students to take up engineering as a career. This is due to a greater need for engineers in society, particularly in areas that are suffering a skills shortage. Both the engineering profession and universities across Australia have moved to address this shortage, with a proliferation of engineering outreach activities and programs the result. The Engineering Link Group (TELG) began the Engineering Link Project (ELP) over a decade ago with a focus on helping motivated high school students make an informed choice about engineering as a career. It also aimed at encouraging more high school students to study maths and science at high school. From the start the ELP was designed so that the students became engineers, rather than just hear from or watch engineers. Real working engineers pose problems to groups of students for them solve over the course of a day. In this way, students experience what it is like to be an engineer. It has been found that the project does help high school students make more informed career choices about engineering. The project also gave the students real life and practical reasons for studying sciences and mathematics at high school. © 2005, Australasian Association for Engineering Educatio

Apprenticeship and training in premodern England

This paper re-examines the economics of premodern apprenticeship in England. I present new data showing that a high proportion of apprenticeships in seventeenth century London ended before the term of service was finished. I then propose a new account of how training costs and repayments were distributed over the apprenticeship contract such that neither master or apprentice risked significant loss from early termination. This new account fits with the characteristics of premodern apprenticeship, as well as with what is known about the acquisition of skills in modern and premodern societies