Do you know how patients in your hospital recover after major elective non-cardiac surgery? Do you know the complication rates in your hospital? Do you know what patient recovery is like? Can you be certain that you, your colleagues and your hospital are providing a good service?
The Perioperative Quality Improvement Programme (PQIP) is trying to address these important questions and in doing so improve patient outcomes across the UK for all of our patients.
So what is this program?
PQIP was started by the National Institute of Academic Anaesthesia’s (NIAA) Health Services Research Centre in 2016.
The initiative is supported by the Royal College of Anaesthetists, Royal College of Surgeons (England), the Royal College of Physicians, the Royal College of Nursing, the Faculty of Intensive Care Medicine and the Faculty of Pain Medicine in addition to a number of professional specialist societies.
The aim of the program is to look at the perioperative care of patients undergoing major non-cardiac surgery and measure complication rates, failure to rescue and patient-reported outcomes up one year after surgery. The aim is to collect data to support local and national quality improvement programs and to support the implementation of best practice using a multidisciplinary approach and reduce variation in processes of care. The key focus is the multidisciplinary approach with the involvement of nurses, surgeons, anaesthetists, managers and patients in the process.
PQIP has so far been adopted by 80 hospitals and is aiming to recruit 70,000 patients over five years. A list of eligible procedures can be found at www.pqip.org.uk.
PQIP aims to support local clinicians and managers to use the data for local service improvement
We, as surgeons, are accustomed to the ‘hard’ outcomes such as length of stay, morbidity, and 30- and 90-day mortality. In addition to these more commonly used measures of quality, PQIP provides patient-focused perioperative data on how our patients recover following major surgery; data that most of us would like to collect but lack the resources to do so. This includes, for example, your patients’ satisfaction with anaesthetic techniques, their pain experience after surgery, whether or not they are enrolled in enhanced recovery pathways, their time to mobilisation, data on patient recovery at six months and disability-free survival at one year. Fortunately, as elective surgery is becoming safer, this recovery data is probably more meaningful. This is the advantage of PQIP. The data from each participating hospital is systematically fed back in real-time using live dashboard along with quarterly and annual reports as well as more commonly used measures of quality such as 30-day mortality and tracking long-term patient outcomes, including disability-free survival at one year. This allows each participating hospital to review and follow their own data longitudinally and to benchmark their local outcomes against other participating centres in the UK. This data is ‘gold’ at the end of the rainbow for surgeons who wish to engage with their management teams to drive local quality improvement programmes.
For those who are not experienced in quality improvement, there is a multitude of resources are available on the PQIP website including teaching tools on how to interpret the data, quality improvement tools, published literature and more.
PQIP published its first annual report in April 2018 (www.pqip.org.uk/pages/ar2018). This first report has shown that 11% of PQIP patients in the UK experience a serious complication, which extends average postoperative length of stay by 12 to 20 days depending on the type of surgery. The report identified five national improvement priorities for perioperative care for 2018-2019 (Figure 1).
PQIP is a straightforward study to open and has been adopted by the National Institute for Health Research (NIHR) as a portfolio study. This means funding can be secured at your local hospital to secure research-nurse support to participate.
We would like to thank those of you who are currently participating in PQIP and we would heartily suggest that you open the study at your local hospital if you are not already involved.
We are confident that the outcomes of this study will lead to improved outcomes for our surgical patients and its power will be increased if every hospital in the UK performing major non-cardiac elective surgery engages.
Ravi Vohra, Olga Tucker, Giuseppe Aresu, National Surgical Leads
on behalf of the PQIP project team