Bedford, James R.; (2025) Development, implementation, and evaluation of postoperative morbidity monitoring in a multicentre UK cohort undergoing major surgery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis investigates the implementation and use of the pomVLAD dashboard within the Perioperative Quality Improvement Programme (PQIP) to report near real-time, risk-adjusted postoperative morbidity outcomes and perioperative care recommendations in NHS hospitals. The aim was to determine whether this intervention improved clinical outcomes, enhanced adherence to care processes, and engaged healthcare professionals in quality improvement (QI) initiatives. Quality in healthcare is a multifaceted concept, encompassing safety, effectiveness, and patient-centred care. Large-scale QI initiatives, such as PQIP, aim to harness data-driven strategies to monitor and enhance perioperative care. However, the complexity of healthcare delivery and the variability of local contexts present challenges to the effective use of such interventions. A bespoke risk-adjustment model for morbidity at postoperative day-7 was developed and validated, demonstrating superior performance compared to existing models. This model was integrated into the pomVLAD dashboard to provide timely, visual feedback on clinical performance. Despite its potential, the dashboard did not lead to significant reductions in postoperative morbidity or improved compliance with care processes during a 12-month follow-up. Engagement with the pomVLAD dashboard varied across sites. While staff valued the dashboard’s visualisation of performance metrics and real-time data, its use was often sporadic and secondary to other static quarterly reports. Facilitators of engagement included local champions, structured QI processes, senior management support, and alignment with national improvement priorities. However, barriers such as limited capacity of clinical teams to respond to data, competing clinical demands, and limited infrastructure for QI activities, and organisational inertia hindered its widespread adoption. This research highlights the importance of tailoring national QI interventions to local contexts, fostering multidisciplinary collaboration, and providing adequate resources for sustained improvement. Future work should explore strategies to integrate data collection into routine care, develop customisable tools for local use, and address systemic challenges to ensure meaningful and sustainable improvements in patient outcomes.

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