The Role of Quality Improvement Projects in a Complex Abdominal Wall Service.

Abstract

Background Complex abdominal wall hernias have proven challenging to manage, and such patients often require abdominal wall reconstruction (AWR). However, in the context of a socialist healthcare service, which is required to provide equal and fair healthcare access to all, the heavy resource burden and non-life-threatening nature of complex abdominal wall hernias mean that this patient group may not be prioritised. In this paper, we outline the significant quality of life (QoL) burden on patients requiring AWR and the importance of quality improvement projects (QIPs) in establishing and streamlining their care as a robust, transferable model across centres. Methodology We undertook the creation of a regional AWR multidisciplinary team meeting and referral proforma, establishing a joint clinic between the Plastics and General Surgery teams and registering a standard operating procedure for the use of progressive pneumoperitoneum in a subset of AWR patients. We collected qualitative data using questionnaires sent out to clinicians and patients as well as used recognised outcome scales (pre- and post-operative European Hernia Society Quality of Life score, otherwise known as EuraHS-QoL score, and post-operative Carolinas Comfort Scale score) to assess responses to QIPs. Results Both clinicians and patients reported positive feelings towards the implemented changes, and scores following progressive pneumoperitoneum showed significant improvement. Conclusions Therefore, we propose that QIPs have a significant role in the establishment and streamlining of services for patients requiring AWR. Through the repeated use of QIPs, a robust, transferable model could be produced, which could then be shared with other regional specialist centres nationwide. As such, effective care could be offered equally to AWR patients for improved outcomes and reduced strain on healthcare resources.