About the Programme
The RESPOND Programme is a five-year programme which aims to develop and test interventions to improve response to patients observed to deteriorate after surgery. We are funded by the NIHR (Programme Grant NIHR200868).
In Emergency General Surgery (EGS), which deals mainly with patients with severe abdominal pain, the death rate after exploratory abdominal surgery to find out what’s wrong (called laparotomy ) is five times higher than for similar routine surgery. Death rates after routine major surgery are lower in bigger hospitals than in smaller ones. We know this is not because larger units have less complications after surgery, but because they respond to them more effectively. An effective response needs both early detection of problems and an efficient rescue system. Monitoring patients’ blood pressure, temperature, heart and breathing rates more reliably has not reduced death rates consistently, suggesting that it is more important to improve rescue systems. Research on why rescue systems sometimes don't work has highlighted communication and co-operation problems, and difficulties in getting specialist help quickly. Involving patients and families in the response may improve this process.
Our plan involves using Human Factors science, which analyses how complex work systems succeed or fail, to analyse real life responses when EGS laparotomy patients deteriorate. We are doing this in four work packages:
Work Package 1: Qualitative study (interviews and focus groups) with staff and patients to learn what works and what doesn't.
Work Package 2: Development of an HF interventions based on results from Work Package 1.
Work Package 3: Develop and test the interventions in a small trial to see if they work, with a qualitative study to assess how and why they might be working.
Work Package 4: Test the interventions in a national randomised trial using Step-wedge cluster design.
What is a Step-wedge cluster randomised trial?
This is an alternative to traditional randomised controlled trials where individual patients are given a 50/50 chance of receiving an intervention or not.
In the RESPOND trial, the intervention is to the way the whole Surgical Emergency Unit works in a hospital, so every patient will be affected. Instead, we are grouping hospitals into ‘steps’ of four in a random order. This means that they will start at different times, with a step of four hospitals starting first, followed by the next, and so on. Assigning the steps randomly helps to avoid a bias towards a particular result.
In each hospital we’ll collect patient data before the intervention starts and again afterwards to see if there is an improvement in overall patient outcomes. We will also look at factors like the financial impact of the interventions, as well as qualitative outcomes such as how staff and patients feel about the interventions and what they think about the process of adopting them at their hospital.