32 research outputs found
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
Thirty critical research needs for managing an ecologically and culturally unique remote marine environment: The Kimberley region of Western Australia
The Kimberley marine environment in Western Australia is widely recognised for its outstanding natural features, vast and remote sea and landscapes, and Indigenous cultural significance. To ensure that adequate baseline information is available to understand, monitor and manage this remote and relatively understudied region, scientific exploration was undertaken between 2012 and 2018 as part of the Kimberley Marine Research Program (KMRP). Whilst this program generated significant amounts of new knowledge about the region, important research gaps remain, that if answered, should improve the capacity of managers to conserve the region\u27s values more effectively. Here, we apply established participatory horizon scanning methods to draw on the expertise and understanding of 24 scientists and 18 managers (12 natural resource managers and 6 healthy country managers) involved in the KMRP, and assess their most essential remaining research needs for informing management of the region. Through this process, we identify a total of 184 research questions spanning seven themes: (i) habitats, (ii) fauna, (iii) ecological processes, (iv) pressures, (v) management, (vi) oceanography, and (vii) geomorphology. Of the 184 questions that formed the basis of this study, 29% related to the theme of ‘management’, followed by questions relating to ‘fauna’ (21%) and ‘pressures’ (20%). Questions assigned to the theme of ‘habitats’ (13%), ‘ecological processes’ (10%), and ‘oceanography’ (6%) were less common, whilst questions that related to ‘geomorphology’ only constituted 1% of all questions provided by study participants. Subtle differences in the types of questions posed by the scientist and manager groups were also evident, with questions relating to ‘ecological process’ and ‘oceanography’ overwhelmingly provided by scientists; questions in the themes ‘fauna’ and ‘management’ were mainly provided by Healthy Country Managers; and questions posed by natural resource managers were distributed evenly among all categories. Quantitative scoring of these questions by participants against set criteria of (i) achievability, (ii) importance, and (iii) the extent to which it represented an actual knowledge gap led to the identification of 30 research questions that if answered, will help to inform the management of the Kimberley marine environment. The majority of these questions (22) were related to ‘management’ though there were also high priority questions on ‘pressures’ (12), ‘habitats’ (11), ‘fauna’ (11) and ‘ecological processes’ (7). These questions can be used to inform and guide research effort and future funding investment in the Kimberley region