Identifying quality in the delivery of emergency general surgery

Project summary

Background

Despite ongoing projects lead by the National Emergency Laparotomy Audit and the Royal College of Surgeons of England, the delivery of high-quality care in emergency general surgery remains a significant concern for clinicians, healthcare providers and patients.

Much of the problem in delivering effective emergency surgical care is a lack of understanding of what constitutes quality in this domain and appropriate resource allocation in order to improve standards.

Currently mortality figures in the UK following emergency surgery are poor. In general surgery alone, emergency cases account for approximately 50% of surgical workload carrying a mortality rate of up to 15%.

Problems in service delivery are multi-factorial with concerns being highlighted in workforce planning, training and barriers to the delivery of effective care from institutional factors. Institutional factors such as access to radiology, emergency theatres and ITU also have a significant role in affecting outcomes in emergency surgery but little is known as to what extent

Furthermore, despite increasing sub-specialisation and work-force pressures, general surgeons in the UK continue to care for both elective and emergency patients simultaneously, with subsequent difficulties in staffing emergency rotas and defining protocols for the care of emergency patients. As a result, numerous models of delivery in emergency general surgery currently exist, examples including: surgeon of the week, regional centres of excellence and trauma centres. However we are yet to identify which is the most effective in improving outcomes.

Aims and outcomes

The aims of this research are to identify factors that contribute to high quality care in the delivery of emergency general surgery.

The UK Quality in Emergency Surgery Taskforce (QuEST) has been created in order to allow for a series of collaborations between the project team and key stakeholders in the delivery of emergency general surgery in the United Kingdom.

It will use a mixed methods design, incorporating several research techniques through a series of interlinked studies and collaborations in order to provide evidence-based recommendations for clinicians and policy makers on the optimal factors required to deliver safe and effective emergency general surgery.

Results from this research can be used by NHS Trusts to assess their strengths and weaknesses around the delivery of emergency surgery in order to improve their services. It can also be used to inform changes in policy required to improve the delivery of emergency surgery at a national level.

Outputs

To come

Useful links

Continuous quality monitoring, feedback and improvement in anaesthetic services