Extrait

Background and study aims More than one million patients undergo surgery each year in the NHS, following which 30,000 patients die without leaving hospital. However, most deaths occur amongst patients who we know are exposed to much greater risks. These patients require longer hospital care and suffer a substantial reduction in functional independence and long-term survival. Advancing age, abdominal surgery and the need for emergency surgery are amongst the strongest factors that can cause problems after an operation. Around 35,000 patients come to NHS hospitals each year with precisely this pattern of risk and undergo a procedure called emergency laparotomy (major surgery to treat a life-threatening problem within the abdomen). Almost 9,000 emergency laparotomy patients will die within three months of surgery. Doctors find that these patients are particularly difficult to treat successfully. However, recent evidence shows that quite basic standards of patient care vary widely between hospitals. In particular, there are large differences in how often a senior surgeon is involved in planning and performing the surgery and the use of planned admission to intensive care after surgery has been completed. Doctors have developed guidelines which set out the important standards of care for emergency laparotomy patients which we believe will work. Unfortunately, previous attempts to implement guidelines to improve patient care on a national basis have proved challenging. By studying the effects of introducing an integrated care pathway on survival for emergency laparotomy patients we would provide robust evidence for the benefits of quality improvement projects. Who can participate? We expect to make use of data describing 27,540 patients undergoing emergency laparotomy over an 85-week period. What does the study involve? Ninety hospitals will be allocated in random order to a quality improvement intervention which will help local staff to deliver the highest possible standard of care for emergency laparotomy patients. This will avoid the need for individual patients to make a decision to take part. Instead, we will use existing systems to provide anonymous data on individual patients. The study is exploring whether fewer patients die within 90 days of surgery in hospitals where the quality improvement project is in place. We will also find out about any effects on later deaths within 180 days following surgery, the number of days patients spend in hospital and the number of patients re-admitted to hospital. We will have in-depth observations and interviews with staff to find out how we can further improve uptake of the pathway. We will also look at the cost effectiveness of this project and evaluate the long-term effects of our intervention in the participating hospitals. What are the possible benefits and risks of participating? There is a high likelihood of benefit to patients in participating hospitals. Learning from this study may help other people undergoing such surgery in the future. Where is the study run from? The study is led by Queen Mary University London (QMUL), in collaboration with the National Emergency Laparotomy Audit and is run from across 90 hospitals in England, Wales and Scotland (UK). When is study starting and how long is it expected to run for? The study will run from March 2014 until April 2017. Who is funding the study? The National Institute for Health Research (NIHR) (UK). Who is the main contact for the study? Dr Kirsty Everingham [email protected]

Critère d'inclusion

• Emergency laparotomy

Liens

• ictrp
• isrctn