Surviving major surgery: protocolised pathways to meet individual need York Teaching Hospital

Major surgery is associated with a significant post-operative complication rate. While mortality rates after major surgery have reduced steadily over the past three decades, morbidity rates have not significantly improved. In addition, the care of patients undergoing major elective or emergency surgery can be costly.

To date, very little attention has been paid to the post-operative management of patients, and it is often left to the more junior members of the surgical team, despite this being when the majority of complications occur.

A team at York Teaching Hospital has developed a perioperative medical service to deliver a suite of interventions aimed at improving surgical outcomes and reducing complications.

The interventions include an enhanced pre-operative risk assessment with early referral to smoking cessation, physiotherapy and dieticians. Daily consultant-led ward rounds provide a comprehensive post-anaesthetic review and nurse-led protocols guide fluid and blood pressure management.

This new way of working has involved rolling out advanced treatments and technologies to the ward environment. Extensive training and consultant level support has meant ward nurses have adopted the innovation safely and effectively.

Analysis of data has shown reductions in both length of hospital stay and complication rates. Feedback from nurses has been positive, with over half of respondents reporting that the new service has improved patient care while not significantly increasing workload. There was also positive informal feedback from patients.

The biggest achievement was successfully integrating the new team and way of working into the surgical ward, and upskilling the surgical staff nurses. Challenges included difficulties recruiting staff to the project and a period of staff turnover which made training difficult. These issues were managed through regular multi-disciplinary meetings, feedback to departments and flexibility when using input from other teams.

The Trust has granted continued support for the service beyond the Innovating for Improvement funding. The team are now exploring the possibility of rolling the service out to other surgical specialties.

This Innovating for Improvement project ran from the beginning of May 2015 until the end of July 2016.

Contacts

For more information about this project, please contact Dr David Yates, Consultant in Anaesthesia and Intensive Care Medicine, York Teaching Hospital or Sara Ma, Specialist Nurse in Perioperative Medicine, York Teaching Hospital.