“The Oxford AHSN added value – before their involvement we were using the technology but not capturing the data properly. Now we have robust data collection. The AHSN also came to the rescue with financial support.”
Dr Venkat Hariharan, Consultant Anaesthetist, Milton Keynes University Hospital

a female operating nurse stands over a patient at the operating table and looks down to what she is doing in the operation. She is joined by a young female nurse and mature male surgeon .In the background the anaesthetist is looking over from his monitors . They are all wearing surgical gowns and protective masks and headwear. they are wearing green gowns . The shot is horizontal waist up , with defocussed background for copy space .Overview

Clinical leaders are working with the Oxford AHSN to improve post-operative patient outcomes following high-risk surgery, leading to safer care, quicker recovery and reduced length of stay.

They have created a decision support tool for providers and commissioners to effectively implement intra operative fluid management (IOFM). This work has broken down traditional barriers and established a consistent approach to maintain optimal fluid status during or immediately after surgery.

The AHSN has added value to local practice by supporting a network of teams of anaesthetists and theatre staff from six acute trusts across the Oxford AHSN region. This approach is accelerating the spread and adoption of innovation, enabling equipment procurement, increasing service standardisation and reducing variation based on best practice.

As well as supporting frontline NHS staff this work is influencing national policy-makers. The project’s Phase 1 Benchmarking Report highlighted barriers to clinical adoption. It was referenced in the NICE review of Medical Technology Guidance 3 (page 5). Phase 2 is now addressing the recommendations from phase 1.

Challenge / problem identified

The use of intra operative fluid management (IOFM) technology enables anaesthetists to monitor and manage a patient’s hydration status during and immediately after major and high-risk surgery such as laparotomies and major elective colorectal surgery.

Doing this effectively minimises post-operative complications and contributes to better recovery. However, at least three different technologies are being used in the Oxford AHSN region alone leading to variations in service and outcomes. Robust evidence on suitability in different circumstances has been lacking.

Use of a standard decision support tool to assess which patients would benefit from IOFM technology could lead to thousands of patients being fit for discharge sooner and save the NHS millions of pounds by reducing post-operative complications and rates of infection, readmission and reoperation.

Actions taken

The project reviewed current practice, securing buy-in from all six acute trusts from across the Oxford AHSN region. The project was led and informed by frontline clinicians, including 130+ anaesthetists, other clinicians, managers, commissioners and suppliers of intra operative fluid management (IOFM) technology. It also worked with Central Manchester University Hospitals NHS Foundation Trust (and through them also the Greater Manchester AHSN). The aim was to understand barriers to clinical adoption, establish benchmark data, identify unwarranted variation, share learning, agree a consistent approach and develop a decision support tool. Oxford AHSN match-funded trust investment in IOFM technology.

Individual reports were produced for each participating organisation. A national report was completed with NHS Benchmarking and NHS Improving Quality, supported by NHS England and the national Enhanced Recovery Programme: http://www.oxfordahsn.org/wp-content/uploads/2015/10/12508_Oxford_AHSN_IOFM_36-page_Report-005.pdf

Impacts / outcomes

This work has broken down traditional barriers and established a consistent approach to maintain optimal fluid status during or immediately after surgery.

Partner acute trusts have been supported to reduce regional variation and achieve adoption target for use of intra operative fluid management (IOFM) technologies of 75%.

A new approach is being adopted across the region based on:

  • Optimising use: promoting use of IOFM technology for procedures and patients in which there is good evidence of benefit
  • Training and education: Working with local teams to understand existing knowledge and experience of IOFM technology; recruiting clinical advocates to educate local teams on the benefits of IOFM
  • Tracking usage: Improving the recording, reporting and coding of IOFM procedures being captured/ coded in practice to further support teams in more targeted use of the technology; reviewing evidence, developing metrics, expanding evidence base, further engaging commissioners and national policy makers.

Oxford Intra Operative Fluid (002)

Plans for the future

The project is continuing to support partners to reduce regional variation and reach the IOFM technology adoption target of 75%. Expansion to support the adoption of IOFM technology in some other clinical areas is being pursued. Promotion of the benefits for patients of optimum use of IOFM technology continues.

Further work is taking place to review evidence, develop metrics, expand evidence base and further engage commissioners and national policy makers.

Which national clinical or policy priorities does this example address?

  • Care and Quality

Start and end dates

2014 – Ongoing

Find out more:

Phase 2 Project Structure

Contact us for help and advice

Dr James Rose, Innovation Adoption Manager, Oxford Academic Health Science Network
M: 07920 500 267
E:  james.rose@oxfordAHSN.org

Martin Leaver, Head of Communications, Oxford Academic Health Science Network
M: 07966 174 183
E: martin.leaver@oxfordahsn.org