This week is Patient Safety Awareness Week, and the coronavirus crisis currently facing the NHS reminds us of the importance of continually driving improvements in patient safety, and providing NHS staff with the necessary space and support to cope with adversity and lead these improvements.
UCLPartners delivers a range of patient safety initiatives, through locally-initiated programmes like our Invasive Procedures Safety Network, and by contributing to national efforts including the Patient Safety Improvement Programme and the Emergency Laparotomy Collaborative – a programme to support improvements in outcomes for patients undergoing emergency abdominal surgery.
Emergency abdominal surgery is common, with over 30,000
patients having this type of surgery every year. 1 in 12 of these procedures
takes place in a UCLPartners hospital. Over the last five years, there have
been national efforts to improve clinical outcomes for these patients after
they were identified as a high-risk group, with one in 10 not surviving at 90
days after their surgery.
The reasons for their poor outcomes are multifactorial and
include patient, organisational and societal factors. Many patients undergoing an
emergency laparotomy are elderly, with multiple co-morbidities, often
presenting with severe sepsis and organ dysfunction.
Using local data, we have helped individual trusts design bespoke local QI solutions to overcome barriers to improvement and to share successes with partners across the network.
Organisational factors are measured against a set of
national standards using the National
Emergency Laparotomy Audit. This valuable data set is fed back to
organisations enabling them to use it to drive local improvement. This is where
the UCLPartners Emergency Laparotomy Collaborative has proved particularly
helpful for partner organisations. Using local data, we have helped individual
trusts design bespoke local QI solutions to overcome local barriers to
improvement and to share local successes with partners across the network.
research from a UCL group, however, has shown that despite national
improvements in organisational factors and overall care, there still remains a
disparity in outcomes that is linked to deprivation around the country, with
clear differences in survival after emergency abdominal surgery in different
Outcomes after emergency laparotomy have steadily improved since the launch of NELA and programmes like the Emergency Laparotomy Collaborative, but future work in this area, and in patient safety more widely, must recognise that improvements in outcomes must not disproportionately favour the better off and instead make every effort to target the most disadvantaged in society.