Protocol for a multicentre, multistage, prospective study in China using system-based approaches for consistent improvement in surgical safety

Abstract

IntroductionSurgical safety has emerged as a crucial global health issue in the past two decades. Although several safety-enhancing tools are available, the pace of large-scale improvement remains slow, especially in developing countries such as China. The present project (Modern Surgery and Anesthesia Safety Management System Construction and Promotion) aims to develop and validate system-based integrated approaches for reducing perioperative deaths and complications using a multicentre, multistage design.Methods and analysisThe project involves collection of clinical and outcome information for 1 20 000 surgical inpatients at four regionally representative academic/teaching general hospitals in China during three sequential stages: preparation and development, effectiveness validation and improvement of implementation for promotion. These big data will provide the evidence base for the formulation, validation and improvement processes of a system-based stratified safety intervention package covering the entire surgical pathway. Attention will be directed to managing inherent patient risks and regulating medical safety behaviour. Information technology will facilitate data collection and intervention implementation, provide supervision mechanisms and guarantee transfer of key patient safety messages between departments and personnel. Changes in rates of deaths, surgical complications during hospitalisation, length of stay, system adoption and implementation rates will be analysed to evaluate effectiveness and efficiency.Ethics and disseminationThis study was approved by the institutional review boards of Peking Union Medical College Hospital, First Hospital of China Medical University, Qinghai Provincial People’s Hospital, Xiangya Hospital Central South University and the Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences. Study findings will be disseminated via peer-reviewed journals, conference presentations and patent papers.

Health Information Technology in Healthcare Quality and Patient Safety: Literature Review

“…The first exploration was across the literature that discussed health IT for prevention of quality and patient safety issues to see exactly how organizations were reporting health IT use to prevent a quality and safety event from even happening . The greatest areas of use were around alerts [ 30 , 31 , 44 , 56 , 58 ], clinical decision support [ 39 , 44 , 47 , 56 ], implementation [ 10 , 32 , 37 , 38 , 56 ], interface design [ 26 , 34 , 42 , 45 , 56 , 59 ], and customized health IT solutions [ 29 , 30 , 32 , 34 , 46 - 50 , 56 , 58 , 59 ]. Customized health IT solutions were anything that described the use of health IT but lacked any specificity beyond that described in this section.…”

“…The next exploration was across the literature that discussed health IT for identification of quality and patient safety issues; in other words, how health IT was used to identify a quality and safety event when it is about to occur . In this regard, similar to prevention (but described differently in the included studies), alerts [ 26 , 30 , 31 , 44 , 56 , 58 ], clinical decision support [ 30 , 31 , 39 , 44 , 56 , 58 ], implementation [ 10 , 32 , 38 , 56 ], and customized health IT solutions [ 10 , 30 , 31 , 34 , 46 - 49 , 52 , 56 , 58 ] were most prominent. For example, alerts, clinical decision support, and customized health IT solutions were all described in the literature as having been implemented to identify a potential quality or patient safety issue, yet the literature also described how the implementation of these could have been better in terms of providing more training to those on the receiving end of the alerts, clinical decision support, or other customized health IT solutions.…”

“…That is to say that these are actions that were reported in the literature that were taken as a result of an event. In regards to action, the major areas were documentation [ 10 , 32 , 37 , 41 , 46 , 56 , 58 ], implementation [ 10 , 32 , 37 , 58 ], and culture [ 10 , 29 , 41 , 53 , 58 ] relative to the use of health IT.…”

Cost‐effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China

“…From three teaching and academic hospitals, data of elective and emergency surgery patients prospectively enrolled in 2015 and 2016 in a research project named MSCP were analysed in this study. Design of MSCP was reported previously . The three study sites, located at Beijing, Shenyang and Changsha, respectively, represent regional and economic variation of China in patient sources and medical practice, thus provide opportunity to investigate variation in routine transfusion.…”

Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China

“…The remaining 25 items were combined in an ‘other’ complication category and remained untargeted in this study because most were technical complications22 with an incidence too low to warrant exploring the regularity. Corresponding risk factors of the three targeted complications categories were identified and quantified to generate practical patterns for grading the risk of patients (as detailed in the study protocol) 20…”