Peri-operative medicine service for high-risk surgery: implementation pilot (POM-SHIP) University College London Hospitals NHS Foundation Trust

Serious post-operative complications occur in more than 15% of patients undergoing major surgery. These can have a lasting effect on health-related quality of life and long-term survival. Audit and research data show that compliance with the many recommended processes for managing high-risk surgical patients is low.

The Royal College of Anaesthetists has proposed the development of peri-operative medicine (POM) teams in order to help reduce post-operative morbidity by providing better coordinated care.

This project by University College Hospitals NHS Foundation Trust will involve developing, implementing and testing the clinical effectiveness of having a POM team in place. The team will consist of anaesthesia and critical care staff, who will provide enhanced peri-operative care for high-risk surgical patients.

The intervention will allow high-risk patients to be identified early, before complications develop. Every eligible patient will undergo screening using a suite of validated risk prediction tools. If they are high-risk, they will be referred to a high-risk assessment service, run by the POM team.

Communication within the multidisciplinary team will be improved so that individually tailored treatment plans can be implemented. These patients will have dedicated follow-up by the team throughout their hospital stay.

The team has initially focused on patients undergoing major urological surgery, then branching out into major thoracic surgery, as these procedures carry a particularly high risk of post-operative complications and early mortality. The pathway is being developed in consultation with patients, primary care, surgeons and nurses, and the learning approach taken will enable continual development and improvement of the pathway.

The project will be evaluated using mixed methods: a quantitative analysis of risk-adjusted postoperative complication rates, a qualitative study looking at the perceptions of staff and patients of the new service, and a health economic analysis of cost effectiveness.

Contacts

For further information about the project, please email Ramani Moonesinghe, Consultant and Honorary Senior Lecturer, and Director, UCL/UCLH Surgical Outcomes Research Centre.