Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

36 2. Statement of Assurance
from the Board
Royal Devon and Exeter NHS Foundation Trust
Quality Report 2012/13
Clinical research
participation
Participation in clinical research
demonstrates the Trust’s commitment
to improving the quality of care we
offer and to making our contribution
to wider health improvement. Our
clinical staff stay abreast of the latest
treatment possibilities and their active
participation in research leads to
successful patient outcomes.
The number of patients receiving
health services provided or subcontracted
by the Royal Devon &
Exeter NHS Foundation Trust in
2012/13 that were recruited during
that period to participate in research
approved by a research ethics
committee was 7,900.
The Royal Devon & Exeter NHS
Foundation Trust is one of the highest
recruiting NHS organisations to clinical
trials in the South West Peninsula. The
Trust was involved in conducting 577
clinical research studies in a wide range
of specialties during 2012/13. During
this period there were over 300 clinical
staff participating in research approved
by a research ethics committee. Over
95% of studies were approved within
30 days of receiving valid application.
The Royal Devon & Exeter NHS
Foundation Trust hosts the Peninsula
Comprehensive Research Network, the
South West Research Design Service and
the Cancer, Stroke and Diabetes Local
Research Networks and the Peninsula
Collaboration for Applied Health Research
and Care, thus playing a significant role
in the region for the National Institute of
Health Research (NIHR).
The Royal Devon & Exeter NHS
Foundation Trust collaborates with
Exeter Medical School, hosting the
NIHR Clinical Research Facility for
experimental medicine. A total of
5500 participants were recruited
into research studies during 2012/13
at this facility. Research focuses on
understanding mechanisms of disease
(mainly in diabetes and cardiovascular
patients) and introducing
improvements to patient care.
The high quality of the research at
the Trust is demonstrated by the level
of external grant funding, which in
2012/13 exceeded £5 million.
Additionally, in the last three years, 400
publications have resulted from our
involvement in research, evidencing
our commitment to transparency and
desire to improve patient outcomes
and experience across the NHS.
CASE STUDY
Emergency laparotomy – a race
against time
Every year, around 160 patients are
admitted to the RD&E requiring
emergency laparotomy. This group
of patients are often very sick and
suffer a high rate of morbidity and
mortality. An audit carried out last
year, by anaesthetists Louise Cossey,
Bruce McCormick and James Pittman,
showed that the RD&E’s mortality rate
for these patients was around14%
– slightly better than the national
average, but enough to motivate the
team to seek improvement.
As a result of that initial study, the
Trust will now take part in a
multi-centre pilot of a new care
pathway, launched on 3rd December
2012. The pathway follows guidance
on best practice issued by the Royal
College of Surgeons and the
National Confidential Enquiry into
Peri-Operative Deaths (CEPOD). It was
designed by the Royal Surrey County
Hospital NHS Foundation Trust, which
has one of the lowest mortality rates in
the country for these patients.
“We know that with emergency
laparotomy patients, we’re in a race
against time to make a diagnosis and
commence life-saving treatment as
soon as possible,” said Dr McCormick.
“The key is to identify these patients
and intervene with antibiotics
and, where indicated, perform
emergency surgery within six hours
of diagnosis, so that they have the
best chance of recovery. We hope
that by close attention to all aspects
of each patient’s care we can achieve
’incremental gains’ that will result in
improved survival of these patients.”
The new pathway adopts a truly
multi-disciplinary approach, involving
staff from the Emergency Department,
Surgery, Anaesthetics, ICU and
Radiology. Key to implementation of
the new pathway is the role of the
Trust’s four Physicians’ Assistants in
Anaesthesia, who provide an on-call
support service. The pilot is running
for six months before being evaluated
for its impact on length of hospital
stay and mortality rates. If, as hoped,
the results show a drop in mortality
then the pathway will be adapted for
ongoing use.