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Optimised and Equitable care for Welsh Cancer Patients undergoing Emergency Surgery

I Grants GraphicDr Rachael Barlow, Cardiff and Vale University Health Board
Start date: March 2017
Duration: 12 months
Funding amount: £30,000

Summary: Barlow

In the UK, around 11,000 patients each year undergo Emergency Cancer Surgery (ECS). About a tenth of these patients are operated on in Wales. We know from numerous reports that patients undergoing ECS have poor outcomes. The risk of death following ECS is high. The average mortality rate for patients during a stay in hospital is 14%, with certain hospitals reporting a three-fold higher death rate.

There are many reasons for the poor outcomes and high death rates. Patients undergoing ECS are amongst the sickest treated by the NHS. They are often elderly, frail and vulnerable and struggling with significant pre-existing illnesses. Patients undergoing ECS often present to hospital with serious life-threatening symptoms. However, once in hospital the care delivered is often disjointed with variations reported both between hospitals and also within hospital wards and departments.

Over the past few years, the Enhanced Recovery after Surgery (ERAS) programme has improved the care for patients undergoing elective surgery. ERAS aims to standardised patient care before, during, and after surgery, ensuring excellent care is delivered. ERAS focuses on delivering excellent patient information, alongside the best possible nutrition and hydration, pain management and early mobilisation where possible. This is all underpinned by skilled surgery performed by expert surgeons.

Since November 2010, the All Wales ERAS programme has improved the care provided to patients undergoing planned cancer surgery. In some Centres the length of recovery for some patients’ was shortened by 25-50%.

We aim to use the principles learnt from ERAS to improve the care of patients having ECS. We will examine the current care provided for patients undergoing ECS. We will determine what improvements and changes are required. This will be followed by a phase of improvement. Newly developed pathways of care based on the ERAS principles will be developed and used for all ECS patients in 2 hospitals in Wales. The final stage of the study will be to evaluate the impact of the care pathway on patient care and outcomes across the rest of Wales.

Through this work we hope to improve the quality of care delivered to patients undergoing ECS using the principles of ERAS.

We will do this by: 
• Exploring the current service provided to patients undergoing ECS by engaging with clinical teams in Cardiff and Vale UHB (C&VUHB) and Abertawe Bro-Morgannwg UHB (ABMUHB).
• Develop ERAS pathways, incorporating the core ERAS care bundles in C&V UHB and ABMUHB.
• Implementing the ERAS pathways for all patients undergoing ECS over a 6 month period in C&V UHB and ABMUHB.
• Evaluating the impact of implementing ERAS principles on the mortality rate for patients within 30 days of surgery.
• Ascertaining the impact of implementing ERAS principles based on the Institute of Medicine’s domains of quality using mortality, complications, patient experience, length of stay, timeliness of surgery and financial measures.
• Contributing to the evidence base on effectiveness of ERAS for cancer patients.
There are many benefits to this study. These include:
• Better understanding of the current provision of ECS and the challenges to delivering this service.
• This study will lead to the development of care pathways which can be shared and used by other hospitals.
• Improve clinical outcomes and patient outcomes for patients having ECS


Dr Rachael Barlow, Cardiff and Vale University Health Board
Professor Wyn Lewis, Cardiff and Vale University Health Board
Mr Barry Appleton, Abertawe Bro-Morgannwg University Health Board
Mr Geoff Clark, Cardiff and Vale University Health Board

This work will be in Partnership with Cardiff University and the Royal College of Surgeons in Wales.