Mixed-methods evaluation of the Perioperative Medicine Service for High-Risk Patients Implementation Pilot (POMSHIP): a study protocol

• Published in: BMJ open 2018-10, Vol.8 (10), p.e021647-e021647
• Main Authors: Walker, David, Wagstaff, Duncan, McGuckin, Dermot, Vindrola-Padros, Cecilia, Swart, Nicholas, Morris, Stephen, Crowe, Sonya, Fulop, Naomi J, Moonesinghe, S Ramani
• Format: Article
• Language: English
• Subjects: Age; Anaesthesia; Anesthesia; Anesthesiology; Delirium; Hospitals; Intensive care; Medicine; Mixed methods research; Morbidity; Mortality; Older people; Ostomy; Patients; Postoperative period; Qualitative research; Risk assessment; Surgery; Surgical outcomes; Systematic review
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-021647

IntroductionPerioperative 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 evaluationA 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 disseminationThe 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.