With an ageing population, increasing numbers of older patients are presenting for surgery.  Those with other health problems who undergo major operations are more likely to develop complications and fail to make a full recovery.  The complexity of modern healthcare means that approaches used to design other complex systems (such as energy or aviation) are increasingly advocated to understand, design, and improve health systems. In our project we aim to explore how healthcare data can be used to supplement such an approach; to identify events and factors associated with older patients losing independence after surgery or suffering another complication (such as a heart attack) whilst in hospital.

We will firstly gain consensus on what defines a ‘high-risk’ patient by searching the literature and canvassing the opinion of healthcare professionals.  This information will inform the generation of a large, anonymised dataset, extracted from our hospital’s electronic health record and use this to identify events, conditions, and factors that are associated with poor outcome after surgery.  In the final phase we will use these findings to explore, simulate, and design potential solutions to these identified problems with the hope of exploring the beneficial effects of such a solution in future work.

Designing Improved Surgical Care for Older people (DISCO) is a joint endeavour run between the University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, and the Engineering Design Centre based in the University of Cambridge department of engineering.  The project aims to:

• Gain a consensus of what constitutes a high risk surgical patient and encounter by seeking the views of key perioperative stakeholders.
• Analyse an anonymised retrospective dataset of surgical cases to identify factors that are associated with poor outcome in older people having surgery
• Explore these findings in a series of interactive workshops with patients and staff to create potential solutions to these identified problems

Key Staff

• Dr Daniel Stubbs – Wellcome Trust Clinical Research Fellow & Specialist Registrar in Anaesthesia
• Dr Ari Ercole – Consultant in Anaesthesia and Intensive Care Medicine
• Prof PJ Clarkson – Director Cambridge Engineering Design Centre

Key Links

• Royal Academy of Engineers – ‘Engineering better care: a systems approach to health and care design and continuous improvement’ 
• Health systems engineering group within the University division of anaesthesia

Funding

DISCO is funded through a Wellcome Trust Clinician PhD Fellowship to Dr Daniel Stubbs.  DISCO is registered on the NIHR portfolio (CPMS ID 40249).