The Perioperative Quality Improvement Programme (PQIP) plans to collect data on patient risk factors, perioperative complications and patient reported outcome measures (PROMS) for patients undergoing major elective surgery.
The data collection is meant to start summer 2016. PQIP will measure risk-adjusted morbidity and mortality, as well as process and patient-reported outcome data in patients undergoing major surgery (lower GI resection, upper GI resection, liver resection, cystectomy, major head and neck reconstructive surgery, thoracic resection).
The pilots will test the QI (Quality improvement Interventions) on improving patient’s outcome and compliance with key processes. It would be a ‘before and after’ study in pilot sites. The PQIP steering committee is hopeful that it would be adopted onto the NIHR portfolio of research studies thereby leading to recruitment of research nurses.
I attended the 2nd CRG meeting in London on the 10th Dec 2015. The first meeting was held in September 2015. They plan to meet up three times a year. PQIP is obviously work in progress. We started off by a systematic review of structure and process measure development for preoperative care. Multiple measures were identified to be included in the PQIP check list. The group proposes to engage the Delphi exercise to finalize the PQIP check list.
The current number of sites that have registered an interest in participating in the pilot phase of PQIP is approximately 80. As per the PILOT study protocol baseline data will be collected in pilot sites for 6 months from September 2016. After baseline data collection, 50% of hospitals will be assigned to the Quality Improvement intervention and comparisons will be made against the control 50% of hospitals. They are aiming to submit protocol with a ‘Set Up’ phase for data collection and piloting the quality improvement intervention. Once any issues are addressed, this would be followed up by a larger roll out with 50% of the hospitals being allocated the intervention. The issue of portfolio adoption was discussed as well. We do not currently know the NIHR view as the portfolio and ethics needs to be submitted together which has not happened yet.
There was some discussion around the type of procedures that should be included in the PQIP study. The chairperson asked for the opinion of the surgeons within the group if the list of included procedures was an accurate representation of the important procedures. I volunteered to look at the list of colorectal procedures.
Patient level dataset was discussed in detail. PQIP is currently using P-POSSUM defined criteria along with other questions. The group discussed the need to include smoking and alcohol consumption within PQIP. It was originally proposed that smoking would be defined as tobacco smoking and not e-cigarettes as stop smoking groups would only help individuals smoking tobacco. However, after lengthy discussion in which trust guidelines on referral to stop-smoking clinics were discussed, it was proposed to drop the question regarding smoking and alcohol as neither would add value to PQIP. I have to say I found that a bit confusing as one would have thought that these two factors are quite important determinants of morbidity? May be something to bring up in the next meeting.
Overall I thought it is a good initiative and we should support it. It is work in progress and I am happy to try and attend their next meeting if my hospital commitments would let me.
Suhail Anwar, Consultant General/Colorectal Surgeon