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Mixed-methods evaluation of the Perioperative Medicine Service for High-Risk Patients Implementation Pilot (POMSHIP):
David Walker1, Duncan Wagstaff1,2, Dermot McGuckin1
1Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK.
Insights
This study evaluates a new Perioperative Medicine Service (POM) for high-risk patients. The service aims to reduce complications and improve outcomes through coordinated care, with findings informing wider implementation.
Area of Science:
- Perioperative Medicine
- Health Services Research
- Patient Outcomes
Background:
- Perioperative complications significantly impact patient quality of life and long-term survival.
- High-risk surgical patients require coordinated care to mitigate adverse postoperative events.
- Perioperative Medicine (POM) services are proposed to improve postoperative outcomes for these patients.
Purpose of the Study:
- To evaluate the impact of a specialist Perioperative Medicine Service (POM) for high-risk patients.
- To determine if the POM service can reduce postoperative morbidity, failure to rescue, mortality, and hospital admission costs.
- To assess the feasibility and effectiveness of implementing a POM service.
Main Methods:
- A mixed-methods service evaluation using a 'before and after' design.
- Clinical effectiveness measured by the PostOperative Morbidity Score, quality of life (EQ-5D), and quality of recovery (Quality of Recovery-15 Score).
- Cost analysis using Patient-Level Information and Costing System data; qualitative process evaluation of staff and patient experiences.
Main Results:
- The evaluation is ongoing, with findings used formatively to refine the service during implementation.
- Data collection includes clinical outcomes, patient-reported outcomes, cost data, and qualitative feedback.
- The study is designed to provide evidence for the potential wider rollout of the POM service.
Conclusions:
- The Perioperative Medicine Service for High-risk Patients Implementation Pilot is being evaluated for its effectiveness and impact.
- Findings will inform service adjustments and guide decisions on scaling the POM model to other healthcare sites.
- This evaluation is crucial for establishing the value of specialized perioperative care in improving patient outcomes and resource utilization.
Introduction:
Perioperative complications have a lasting effect on health-related quality of life and long-term survival. The Royal College of Anaesthetists has proposed the development of perioperative medicine (POM) services as an intervention aimed at improving postoperative outcome, by providing better coordinated care for high-risk patients. The Perioperative Medicine Service for High-risk Patients Implementation Pilot was developed to determine if a specialist POM service is able to reduce postoperative morbidity, failure to rescue, mortality and cost associated with hospital admission. The service involves individualised objective risk assessment, admission to a postoperative critical care unit and follow-up on the surgical ward by the POM team. This paper introduces the service and how it will be evaluated.
Methods And Analysis Of The Evaluation:
A mixed-methods evaluation is exploring the impact of the service. Clinical effectiveness of the service is being analysed using a 'before and after' comparison of the primary outcome (the PostOperative Morbidity Score). Secondary outcomes will include length of stay, validated surveys to explore quality of life (EQ-5D) and quality of recovery (Quality of Recovery-15 Score). The impact on costs is being analysed using 'before and after' data from the Patient-Level Information and Costing System and the National Schedule of Reference Costs. The perceptions and experiences of staff and patients with the service, and how it is being implemented, are being explored by a qualitative process evaluation.
Ethics And Dissemination:
The study was classified as a service evaluation. Participant information sheets and consent forms have been developed for the interviews and approvals required for the use of the validated surveys were obtained. The findings of the evaluation are being used formatively, to make changes in the service throughout implementation. The findings will also be used to inform the potential roll-out of the service to other sites.
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