REVIEW ARTICLE
Time for metrics in emergency surgical care – the role of an emergency surgery registry
,
 
,
 
,
 
 
 
 
More details
Hide details
1
EU INTERREG Centre for Personalised Medicine, Intelligent Systems Research Centre, School of Computing, Engineering, and Intelligent Systems, Ulster University, Northern Ireland, United Kingdom
 
2
Department of Surgery, Altnagelvin Hospital Derry, Northern Ireland, United Kingdom
 
3
Raigmore Hospital Inverness, Scotland, United Kingdom
 
4
Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Ireland
 
 
Publication date: 2019-08-14
 
 
Anaesthesiol Intensive Ther 2019;51(4):306-315
 
KEYWORDS
ABSTRACT
There is abundant local, national, and international evidence that clinical decision-making in emergency general surgery (EGS) is frequently sub-optimal, and this has a negative impact on the quality and safety of care and patient outcomes. The barriers to achieving high-quality, safe, and effective EGS care across health systems are manifold and multifactorial. It is suggested that emergency surgery registries may provide a suitable foundation to enable interventions that lead to improvements in quality in this area.
Data from surgical registries may serve multiple purposes, including improving the quality of healthcare and the enhancement of patient safety. The increasing sophistication and analytic capabilities of clinical registries and databases contribute considerably in all of these domains due to their use of accurate, credible, risk-adjusted, and concurrent clinical data, which are acquired for these specific purposes.
The emergency surgery outcomes advancement (eSOAP) project commenced during late 2018, with the aim of establishing the feasibility of prospective data capture on all EGS admissions and assessing the outcomes and impact of clinical pathways for patients admitted to EGS services in Letterkenny University Hospital (Republic of Ireland), Altnagelvin Hospital (Northern Ireland), and Raigmore Hospital (Scotland).
eSOAP seeks to address deficits in EGS care by enabling an assessment of patient outcomes, enhancing the quality and safety of patient care, and providing an effective template for EGS registry development. It will achieve this through the provision of meticulous, valid, risk-adjusted, and concurrent clinical data. The comprehensive information within the eSOAP registry will promote transparency in respect of the functioning of individual surgical teams and services and increase understanding of the complex systems involved in the delivery of EGS care.
REFERENCES (40)
1.
Santry HP, Madore JC, Collins CE, et al. Variations in implementation of acute care surgery: results from a national survey of university-affiliated hospitals. J Trauma Acute Care Surg 2015; 78: 60-67. doi: 10.1097/TA.0000000000000492.
 
2.
Tan BH, Mytton J, Al-Khyatt W, et al. A comparison of mortality following emergency laparotomy between populations from New York state and England. Ann Surg 2017; 266: 280-286. Doi: 10.1097/SLA.0000000000001964.
 
3.
Royal College of Surgeons of England (RCSE). Emergency Surgery: Standards for unscheduled surgical care. Guidance for providers, commissioners and service planners. The Royal College of Surgeons of England; 2011. Accessed at: www.rcseng.ac.uk/publications/docs/emergency-surgery-standards-for-unscheduledcare.
 
4.
Shafi S. Pursuing Quality – Emergency General Surgery Quality Improvement Program (EQIP); 2015. Accessed at: https://www.mdedge.com/surgery....
 
5.
Becher RD, Meredith JW, Chang MC, et al. Creation and implementation of an emergency general surgery registry modeled after the National Trauma Data Bank. J Am Coll Surg 2012; 214: 156-163. doi: 10.1016/j.jamcollsurg.2011.11.001.
 
6.
Chana P, Joy M, Casey N, et al. Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative. BMJ Open 2017; 7: e014484. doi: 10.1136/bmj­open-2016-014484.
 
7.
Scott JW, Olufajo OA, Brat GA, et al. Use of national burden to define operative emergency general surgery. JAMA Surg 2016; 151: e160480. doi:10.1001/jamasurg.2016.0480.
 
8.
Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ; UK Emergency Laparotomy Network. Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth 2012; 109: 368e75. doi: 10.1093/bja/aes165.
 
9.
Watson R, Crump H, Imison C, Currie C, Gaskins M. Emergency general surgery: challenges and opportunities. Research Report. Nuffield Trust, London 2016.
 
10.
Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample – 2001 to 2010. J Trauma Acute Care Surg 2014; 77: 202-208. doi: 10.1097/TA. 0000000000000362.
 
11.
Department of Health. Hospital Statistics: Inpatient and Day Case Activity Statistics 2016/17. 2017.
 
12.
Royal College of Surgeons in Ireland (RCSI). Model of Care for Acute Surgery and the National Policy and Procedure for Safe Surgery. Royal College of Surgeons in Ireland, 2013.
 
13.
Daniel VT, Ingraham AM, Khubchandani JA, Ayturk D, Kiefe CI, Santry HP. Variations in the delivery of emergency general surgery care in the era of acute care surgery. Jt Comm J Qual Patient Saf 2019; 45: 14-23. doi: 10.1016/j.jcjq.2018.04.012.
 
14.
Lim DW, Ozegovic D, Khadaroo RG, Widder S. Impact of an acute care surgery model with a dedicated daytime operating room on outcomes and timeliness of care in patients with biliary tract disease. World J Surg 2013; 37: 2266-2272. doi: https://doi.org/10.1007/s00268....
 
15.
Chana P, Burns EM, Arora S, et al. A systematic review of the impact of dedicated emergency surgical services on patient outcomes. Ann Surg 2016; 263: 20-27. doi: 10.1097/SLA.0000000000001180.
 
16.
Symons NR, Moorthy K, Almoudaris AM, et al. Mortality in high-risk emergency general surgical admissions. Br J Surg 2013; 100: 1318-1325. doi:10.1002/bjs.9208.
 
17.
Dijkink S, van der Wilden GM, Krijnen P, et al. Polytrauma patients in the Netherlands and the USA: a bi-institutional comparison of processes and outcomes of care. Injury 2018; 49: 104-109.
 
18.
Mealy K, Keane F, Kelly P, Kelliher G. What is the future for general surgery in model 3 hospitals? Ir J Med Sci 2017; 186: 225-233. doi: 10.1007/ s11845-016-1545-0.
 
19.
Royal College of Surgeons in Ireland (RCSI). Model of Care for Acute Surgery and the National Policy and Procedure for Safe Surgery. Royal College of Surgeons in Ireland; 2013. Accessed at: http://www.rcsi.ie/files/ surgery/docs/20131030121710_RCSI_Model_of_Care_for_Acute_S.pdf.
 
20.
Royal College of Surgeons in Ireland (RCSI). Surgical Services 2020 and Beyond. Royal College of Surgeons in Ireland; 2017. Accessed at: http://www.rcsi.ie/files/surge....
 
21.
Royal College of Surgeons of England (RCSE). Emergency surgery policy briefing. The Royal College of Surgeons of England, 2014.
 
22.
Anderson I. The future of emergency surgery – a joint document. Association of Surgeons of Great Britain and Ireland; 2015. Accessed at: https://www.acpgbi.org.uk/cont....
 
23.
Institute of Medicine. IOM report: the future of emergency care in the United States health system. Acad Emerg Med 2006; 13: 1081-1085. doi: 10.1197/j.aem.2006.07.011.
 
24.
Sugrue M, Maier R, Moore EE, et al. Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland. World J Emerg Surg 2017; 12: 47. doi: 10.1186/s13017-017-0158-x.
 
25.
Behar N, King D. Proposal for a new specialty: emergency general surgery; 2012. Accessed at: http://careers.bmj.com/ careers/advice/view-article.html?id=20007882.
 
26.
Lyu HG, Najjar P, Havens JM. Past, present, and future of Emergency General Surgery in the USA. Acute Med Surg 2018; 5: 119-122. doi: 10.1002/ams2.327.
 
27.
Baggaley A, Robb L, Paterson-Brown S, et al. Improving the working environment for the delivery of safe surgical care in the UK: a qualitative crosssectional analysis. BMJ Open 2019; 9: e023476. doi: 10.1136/bmjopen-2018-023476.
 
28.
Evans SM, Scott IA, Johnson NP, et al. Development of clinical-quality registries in Australia: the way forward. Med J Aust 2011; 194: 360-363. doi: 10.5694/j.1326-5377.2011.tb03007.x.
 
29.
Larsson S, Lawyer P, Garellick G, et al. Use of 13 disease registries in 5 countries demonstrates the potential to use outcome data to improve health care’s value. Health Aff (Millwood) 2012; 31: 220-227. doi: 10.1377/hlthaff.2011.0762.
 
30.
Hoque DME, Kumari V, Hoque M, Ruseckaite R, Romero L, Evans SM. Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review. PLoS One 2017; 12: e0183667. doi: 10.1371/journal.pone.0183667.
 
31.
Hickey GL, Grant SW, Cosgriff R, et al. Clinical registries: governance, management, analysis and applications. Eur J Cardiothorac Surg 2013; 44: 605-614. doi: 10.1093/ejcts/ezt018.
 
32.
Gliklich RE, Dreyer NA, Leavy MB. Registries for evaluating patient outcomes: a user’s guide. 3rd ed. Agency for Health Care Research and Quality, 2014.
 
33.
Fonarow GC, Yancy CW, Heywood JT. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch Intern Med 2005; 165: 1469-1477. doi: 10.1001/archinte.165.13.1469.
 
34.
Fonarow GC, Albert NM, Curtis AB, et al. Improving evidence-based care for heart failure in outpatient cardiology practices primary results of the registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Circulation 2010; 122: 585-596. doi: 10.1161/CIRCULATIONAHA.109.934471.
 
35.
Breckenridge K, Bekker HL, Gibbons E. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting. Nephrol Dial Transplant 2015; 30: 1605-1614. doi: 10.1093/ndt/gfv209.
 
36.
Stey AM, Russell MM, Ko CY, et al. Clinical registries and quality measurement in surgery: a systematic review. Surgery 2015; 157: 381-395. doi: 10.1016/j.surg.2014.08.097.
 
37.
Sedrakyan A, Campbell B, Graves S, Cronenwett JL. Surgical registries for advancing quality and device surveillance. Lancet 2016; 359: 1358-1360. doi: 10.1016/S0140-6736(16)31402-7.
 
38.
Coccolini F, Kluger Y, Ansaloni L, et al. WSES worldwide emergency general surgery formation and evaluation project. World J Emerg Surg 2018; 13: 13. doi: 10.1186/s13017-018-0174-5.
 
39.
National Policy Statement on Ensuring Research Integrity in Ireland; 2014. Accessed at: https://www.iua.ie/publication... national-policy-statement-on-ensuring-research-integrity-in-ireland/.
 
40.
Sanchez J, Barach P, Johnson JK, Jacobs JP. Surgical Patient Care: Improving Safety, Quality and Value. Springer International Publishing, 2017; 909. doi: https://doi.org/10.1007/978-3-....
 
eISSN:1731-2531
ISSN:1642-5758
Journals System - logo
Scroll to top