Research nurses Andrew Padwick and Diane Daniel with Dr Robert Hartley

Improving care and treatment for patients having major surgery

Around 10 million operations are performed in the NHS each year.  Of these up to 1 million would be considered ‘high risk’.

About 1 in 10  patients has serious complications after major surgery and these can affect long-term quality of life and survival.

Despite that, there is little national data about the rates of complications in different hospitals or how effectively we treat them – and that’s why Salford Royal, the Royal Oldham and North Manchester General Hospitals are among more than 90 UK hospitals involved in a major long-term study into perioperative care.

The PQIP (Perioperative Quality Improvement Programme) aims to improve the care and treatment of patients having major surgery by collecting information about them, their surgery and their recovery. As well as looking at the way patients are cared for before and after their surgery, and measuring complication rates, the study also asks patients how they feel about their health and quality of life at the time of the operation and six and 12 months later.

Dr Robert Hartley is Principal Investigator for the study at Salford Royal, working with research nurses Diane Daniel, Andrew Padwick (pictured) and Pablo Rodriguez. Patients having upper gastrointestinal, colorectal and major urology surgery are currently able to take part at Salford, which is the second highest recruiter nationally with more than 500 patients.

The wealth of information they’re collecting is  informing new local projects designed to improve patient care and most importantly patient outcomes.

Dr Hartley explained: “PQIP has identified five targets for improvement – anaemia, the risk assessments we carry out before treatment, enhanced recovery after surgery, pain management and drinking, eating and mobilising after surgery.

“We’ve been reviewing our data in collaboration with surgical and medical colleagues so we can test innovations and interventions to improve patients’ experiences.

“One example of this was an  observational study with two recovery nurses acting as hydration champions, actively encouraging patients to drink as soon as possible after their surgery. We know that the sooner they drink, the sooner patients return to normal gut function, have their intravenous fluids removed and can go home. You might not always feel like drinking when you’re coming round from anaesthetic though, so we wanted to test whether having the hydration champions made a difference.

“We are also carrying out a study to improve the evidence base on how people with diabetes recover after surgery. Current national guidelines recommend a carbohydrate drink before surgery to build energy reserves and minimise the stress response to surgery. But there is a lack of evidence internationally for this so we have designed a study to look at patient outcomes locally.”

You can read more about PQIP, which was established in 2016 by the National Institute of Academic Anaesthesia’s (NIAA) Health Services Research Centre, working on behalf of the Royal College of Anaesthetists, on its website.