For Patients

Information for Patients about PQIP

PERIOPERATIVE MEDICINE describes the practice of patient-centred, multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery. Patients are at the centre of Perioperative Medicine and should be empowered to participate fully in their own healthcare choices, making well-informed decisions about all aspects of their care. One of its core aims is to minimise the risk to patients of developing complications during and after surgery. 
 
The types of complication which may occur range from the relatively minor and short-lived, but which can be distressing to patients (for example, nausea and vomiting due to the type of anaesthesia or surgery) to very significant complications such as infection, bleeding or blood clots, which can cause longer-term harm. This risk of developing complications is specific to the individual patient and will be dependent on their general health, fitness and the type of surgery they are having. There are a number of ways in which clinical teams and patients can work together to minimise the risk of harm and improve the management of medical illnesses that may occur around the time of surgery. Perioperative care involves input from several different teams including anaesthesia, surgery, intensive care, general practice and many other allied specialties and professions.

In the UK it is estimated that 10 million operations are performed in the NHS each year. 
Research data from both the UK and USA indicate the number of patients who develop complications or die after surgery varies between hospitals. Some of this variation may be due to differences in patient health and fitness; however, some of it may be due to the care which patients receive in hospital. This suggests that there may be opportunities to improve standards and the results of surgery  patients’ long-term health and quality of life. To address these issues, the NIAA Health Services Research Centre, working on behalf of the Royal College of Anaesthetists, established the Perioperative Quality Improvement Programme (PQIP) in 2016. 

The aim of PQIP is to investigate how patients are treated when having major surgery, measure complication rates and patients’ perspectives on their care and recovery, and then report this information back to the NHS so that we can improve care for future patients. 
We started this programme in a limited number of hospitals but aim to include all NHS hospitals over the next 5-10 years. The goal is to deliver real benefits to patients by supporting clinicians in using the data for improvement. We want to reduce surgical complication rates, improve patient experience and quality of life after surgery. So far about 90 hospitals are taking part in PQIP and it is supported by all the relevant professional medical and nursing bodies including the Royal College of Surgeons (England), the Royal College of Physicians, the Royal College of Nursing, the Faculty of Intensive Care Medicine and the Faculty of Pain Medicine. We have also involved patients in the design of our methods and plans from the outset.

We hope to reduce variation and improve the quality of care for thousands of surgical patients. 
However, collecting all this information would be impossible if we included all surgical procedures. Therefore, we will be assessing a random selection of five patients in each hospital taking part every week. By measuring the quality of care and how patients recover from particularly high risk surgical procedures, we hope to learn important lessons about how we can improve perioperative healthcare. An important part of the programme is that we ask patients to provide information on their general health and wellbeing several times throughout their participation in the study. This is because we know that some patients who develop complications in hospital after surgery can have a reduced quality of life in the longer term. By understanding how patients' perspectives on their care and recovery relate to perioperative risk factors and complications after surgery, we will be able to learn how to improve care for future patients.

In summary, prevention and management of different perioperative complications requires different strategies and input from many clinical specialties. Measuring and understanding the rates and reasons for complications after surgery is important for hospitals so that they can make changes aimed at improving patient care and satisfaction.