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Systematic Reviews

Overview

Establishing the current evidence base is an important starting point for all academic endeavour. The systematic review programme has been running since the inception of the HSRC and has predominantly focused on establishing our understanding of risk prediction and adjustment systems, and outcome measures which are applicable to anaesthesia, perioperative and surgical care.

Reviews so far

Two systematic reviews have been published to date (and are available open access) and another is currently undergoing peer review. In 2015, the HSRC, in collaboration with the RCoA Professional Standards committee will publish two evidence-based guidelines for professional practice which are based on the results of these systematic reviews and include input from clinical experts. These guidelines will offer practical solutions for the implementation of risk-prediction methodology and patient-reported outcome measurement in anaesthesia and perioperative care.

Further initiatives

The systematic review programme is the foundation of two further major initiatives for the HSRC. The first is the Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC) process. This will define a set of core outcome measures for use in clinical trials and audits, and is part of the wider COMET (Core Outcome Measures in Effectiveness Trials) initiative. This process is being conducted in conjunction with another international initiative, of which the HSRC is a partner organisation, to define standardised endpoints for clinical trials.

The second stream of work is to define a series of process measures for the purposes of improving postoperative outcomes. The Perioperative Quality Improvement Project will measure risk-adjusted outcome (in particular postoperative complications and patient reported outcome) in a sample of patients undergoing major surgery in NHS hospitals. A pilot study will begin in 2016.

If, through this system, particular outcomes are found to be of concern in individual Trusts, a closer look at processes will be required in order to address these concerns and improve outcomes. Thus, a suite of systematic reviews are underway to determine the evidence-base for preventing different types of postoperative complications (e.g. infections, respiratory complications etc.) These reviews will lead to stakeholder engagement and expert consensus meetings which will determine a suite of performance indicators which can be measured at Trust level for the purposes of quality improvement. More about this work can be found here.