Implementation of a Shoulder Soft Tissue Injury Triage Service Improves Time to Surgery

"Our new service resulted in surgical repair of traumatic rotator cuff tears 29 days faster than the traditional system with an extra 38% of patients having surgery within 90 days of injury - a benchmark thought to improve outcome. Future work will aim to improve this percentage further and include long term patient follow up of outcome measures after surgery."

Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.
M Bateman, G Davies-Jones, A Tambe, DI Clark
BMJ Quality Improvement Reports 2016;5: doi:10.1136/bmjquality.u211254.w4531

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Improving the quality of the surgical preoperative assessment in a district general hospital

"The interventions described proved to be cheap and effective methods of improving the quality of the preoperative assessment, bringing it in line with the anaesthetic assessment and reducing the risk of same day cancellations."

Improving the quality of the surgical preoperative assessment in a district general hospital
J Koris, C Hopkins
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u205381.w3406

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Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings

"The changes made to the process have resulted in a real reduction in the time spent preparing each weekly meeting. As a result of careful and thoughtful improvement cycles, it has been possible to increase the proportion of patients discussed at each meeting by approximately two thirds."

Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings
Gary Dobson, Declan Neeson
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208416.w3332
Programme

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Improving the recording of surgical drain output

"We have demonstrated that the introduction of a simple and well-designed drain chart can significantly improve the documentation of drain output, thereby improving patient safety and discharge efficiency."

Improving the recording of surgical drain output
Nicholas Lyons, Paul Heron, Rob Bethune
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u209264.w3964

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Characterising ‘near miss’ events in complex laparoscopic surgery through video analysis

"Error awareness is essential in daily surgical practice and surgical training. The current study highlights the benefits of detailed video analysis to create a database of common injury mechanisms and video clip repository that can be used in tailoring future training interventions."

Characterising ‘near miss’ events in complex laparoscopic surgery through video analysis
EM Bonrath, LE Gordon, TP Grantcharov
BMJ Quality and Safety 2015;24:516-521 doi:10.1136/bmjqs-2014-003816

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Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires

"Current estimates for wrong-site surgery and retained surgical items are 1 event per 100 000 and 1 event per 10 000 procedures, respectively, but the precision is uncertain, and the per-procedure prevalence of surgical fires is not known. "

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires: A Systematic Review of Surgical Never Events 
S Hempe et al.
JAMA Surgery June 10, 2015. doi:10.1001/jamasurg.2015.0301

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Commissioning Guide: Cataract Surgery

"Commissioning of cataract care should encompass the whole cataract care pathway from initial assessment and treatment planning to final postoperative review"

Commissioning Guide: Cataract Surgery
The Royal College of Ophthalmologists
February 2015

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Use of nurse-led telephone follow-up as a sole method of assessing patients after nasal surgery

"The project demonstrates that nurse-led follow up is an efficient, effective and safe way of managing patient care post-nasal surgery."

Use of nurse-led telephone follow-up as a sole method of assessing patients after nasal surgery
P Sooby, P Kirkland
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u208386.w3311

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The IDEAL Collaboration

"The IDEAL Collaboration is an initiative to improve the quality of research in surgery... IDEAL is a set of recommendations for the evidence-based practice of surgery. It is geared towards participants in all stages of gathering and using evidence for the ultimate goal of improving outcomes for patients."

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Improving theatre efficiency and utilisation

"Surgical departments are increasingly put under pressure to improve services, cut waiting lists, increase efficiency and save money. At a district general hospital in the west-midlands we approached the challenge of improving efficiency and optimising the services available in our orthopaedic theatres."

Improving theatre efficiency and utilisation through early identification of trauma patients and enhanced communication between teams
S Roberts, A Saithna, R Bethune

BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206641.w2670

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Improving patient flow in pre-operative assessment

"This improvement project sought to decrease waiting times for patients at a pre-operative assessment service at Raigmore Hospital in Inverness, and to increase the proportion of patients who were seen on the same day as the decision to operate was made."

Improving patient flow in pre-operative assessment
C Stark, A Gent, L Kirkland
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u201341.w1226

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Identification of promising strategies to sustain improvements in hospital practice

"Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative."

Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study
SMC Ament, F Gillissen, A Moser, JMC Maessen, CD Dirksen, MF von Meyenfeldt, T van der Weijden
BMC Health Service Research, 2014; 14(1): 641. doi:  10.1186/s12913-014-0641-y

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The reconfiguration of clinical services

"This paper aims to help those planning and implementing major clinical service reconfigurations ensure that change is as evidence-based as possible. It investigates the five key drivers – quality, workforce, cost, access and technology"

The reconfiguration of clinical services: What is the evidence?
C Imison, L Sonola, M Honeyman, S Ross
The King's Fund
November 2014

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Optimising calcium monitoring post thyroid and parathyroid surgery

"Implementing five simple interventions has been shown to greatly improve the monitoring of calcium post-operatively, and ultimately improve patient safety at the Royal Devon & Exeter Hospital."

Optimising calcium monitoring post thyroid and parathyroid surgery
E Rayner, N Williams, J Dunn
BMJ Quality Improvement Reports 2014;3: doi:10.1136/bmjquality.u204844.w2048

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Bed rest and posture for preventing post-dural puncture headache

"There are no clear benefits associated with either bed rest or fluid supplementation. It is not current practice for patients to be kept in hospital strictly for bed rest and so this review would not result in the freeing up of beds but there may be cash savings from the reduced use of intravenous fluids."

Bed rest and posture for preventing post-dural puncture headache
The Cochrane Collaboration
September 2014

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Exploring variations in access to surgery among older people

"CCGs should evaluate their treatment rates across each 

procedure and seek to explain whether, and if so why, their rates are appropriate. 

CCGs should look to benchmark their own rates against those of their peers, identify 

what action is required to improve access to treatment for older patients and improve 

their assurance process through changes across the commissioning cycle."

Access all ages 2: exploring variations in access to surgery among older people

Royal College of Surgeons, Age UK
July 2014

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Surgeon's experiences of receiving peer benchmarked feedback

"Policy makers and researchers need to increase professionals’ awareness of the numerous purposes and benefits of using PROMs"

Surgeon's experiences of receiving peer benchmarked feedback using patient-reported outcome measures: a qualitative study
MB Boyce, JP Browne, J Greenhalgh
Implementation Science, 2014, 9: 84

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Relationship between patient reported experience and patient reported outcomes in elective surgery

"our results have implications for the concerns of some clinicians who have questioned whether the effectiveness and safety of their practice (measured using PROMs) may instead reflect patients’ views of their level of satisfaction with the experience of care"

Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery
N Black, M Varaganum, A Hutchings
BMJ Quality and Safety, 2014; 23: 534-542

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RCS commissioning guide: general children’s surgery

"Commissioners should aim to build on the successes of existing clinical networks. Where these networks do not exist, commissioners should aim to create them. The south west, North West and the East Midlands have developed a network approach to general paediatric surgery which provides a good reference point."

Commissioning guide: provision of general children’s surgery
Royal College of Surgeons, British Association of Paediatric Surgeons

April 2014 

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RCS commissioning guide: temporomandibular joint disorders

"The aim of this guidance is to provide clarity to commissioning organisations as to the services which should be available to patients with TMD. This guidance aims to address problems that have arisen in recent years with regard to over referral to secondary care of patients with simple problems that could be treated in the community and with others who suffer from a post code lottery with regard to funding of more complex procedures." 

Commissioning guide: temporomandibular joint disorders
Royal College of Surgeons
May 2014

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