Researchers from Queen Mary University of London studied the effectiveness of one of the largest ever national quality improvement (QI) programmes in the NHS and found no improvement in patient survival.
Inpatient surgery in the NHS has a 30-day mortality rate of 1.5 per cent. However, 30-day mortality after emergency bowel surgery is 10 per cent. In 2013, the National Emergency Laparotomy Audit was launched with the aim of implementing a care pathway for patients undergoing emergency abdominal surgery.
Published in the Lancet this week, a stepped-wedge cluster-randomised trial of 15,873 patients aged 40 years or older recruited from 93 NHS hospitals. The primary outcome of 90-day mortality was calculated based on data from 8482 patients in the usual care group and 7374 in the QI group.
The 90-day mortality rate was 16 per cent in both the QI group and usual care group (HR, 1.11; 95% CI, 0.96-1.28).
The authors say there was good engagement with the QI programme, but staff had limited time and resources to implement change. Consequently, there were only modest overall changes in the processes of patient care from before to after QI implementation. There were also wide variations in how the QI was implemented between hospitals, with differences in the processes that teams tried to change, the rate of change and eventual success.
The authors say the findings show that the context of QI is far more complex than previously thought, especially in large national programmes.