Improving care for cSDH and other specialist surgeries
Research type
Research Study
Full title
Specialist surgical care systems (EPI-SPEC-SURG) and their relevance to patient outcome and experience: learning from an improvement study in the care of chronic subdural haematoma (IMPROVE-CSDH).
IRAS ID
351692
Contact name
Daniel James Stubbs
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust and University of Cambridge as Joint Sponsors
Duration of Study in the UK
4 years, 7 months, 30 days
Research summary
Certain surgical specialties like neurosurgery or vascular surgery are centralised given the low volume, high complexity, nature of their work. Although pathways exist to facilitate rapid patient transfer for conditions like trauma, for many other conditions, especially those requiring ‘expedited’ but not ‘time-critical’ surgery, such systems do not exist.
Effectiveness of such pathways have the potential to be affected by surrounding geography. Given the more rapid ageing of rural as opposed to urban communities this creates the potential for a disproportionate number of patients who need specialist surgery to live far from where it is delivered. Given well documented differences in health and socioeconomic status for those living in rural and coastal areas there is a risk that the arrangement of specialist surgical pathways relying on inter-hospital transfer could worsen pre-existing inequalities.
Chronic subdural haematoma (CSDH) is a common neurosurgical condition affecting older, medically complex patients. Care is split between institutions, with up-to 90% of patients requiring surgery initially being admitted to, and transferred from, their local hospital. This transfer contributes to prolonged stay, poor communication, negative experience, and the risk of deterioration although whether this reflects baseline differences or system induced harm is uncertain.
This project seeks to explore these questions - looking to understand whether new cross site pathways and national guidance for CSDH can be implemented and improve outcome, to use national and regional datasets to define the epidemiology of specialist surgery more broadly, and identify pathways exhibiting similar vulnerability to those for cSDH. Taken together it then uses qualitative and quantative data to formally test the hypothesis that referral route impacts on patient outcome.
REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
25/PR/0311
Date of REC Opinion
4 Apr 2025
REC opinion
Further Information Favourable Opinion