Identifying quality in the delivery of emergency general surgery

The delivery of high-quality emergency general surgical care remains a concern for clinicians, healthcare providers and policy makers. Emergency admissions contribute to approximately half of a general surgeon’s workload, however the morbidity and mortality figures seen in this cohort are up-to ten times higher than those seen in elective practice. Despite considerable advances in surgical technology and peri/post-operative protocols over the past twenty years, there appears to be little improvement in outcome following emergency surgical admissions. It is therefore proposed that the delivery of emergency surgical services and hospital structure may significantly contribute to the poor outcomes seen in the acute setting and a greater understanding of the factors that contribute to high-quality care is required. An introduction to the factors that contribute to the delivery of emergency general surgery is presented along with the concepts of examining and identifying quality both in healthcare and other high-risk industries. A systematic review then examines the different models of care seen in the delivery of emergency general surgery across the world along with their effect on outcome and sets the scene for the areas of interest in this thesis. A series of inter-linked, mixed methods studies combining: quantitative analyses of an international dataset, ethnographic observation, a healthcare failure mode effects analysis and audit to identify structural factors that lead to improved outcomes in the delivery of emergency general surgery. The themes of high-quality care, hospital structure, international benchmarking and their association with outcome run throughout these studies in this thesis with outcome data from hospitals in Australia, the United Kingdom and the United States being compared. This thesis highlights a series of unit-level quality indicators whose introduction can be associated with high-quality care and be directly translated into clinical practice using quality improvement methodologies to ultimately improve patient care.Open Acces