PhD Study : Variation in Surgical Care – Determining the scale of the problem

Summary

Currently Emergency Surgery accounts for 10% of all admissions to Irish Hospitals, with over 150,000 patients admitted annually in the island of Ireland. There are 36,000 Emergency Department attendances in LUH annually with circa 1000 admissions to general surgery. There were 54,742 new attendances and 60,739 (includes re-attenders) to Altnagelvin Emergency Department in 2015. 4204 referrals were made to general surgery and approximately 2049 of those were admitted. There is abundant local, national and international evidence that clinical decision making is frequently sub-optimal e.g. inefficient triage of patients presenting with abdominal pain, wide variability in diagnostic pathology testing rates between clinical teams, wide variability in outcome rates following emergency surgery and failure to recognise and treat acute kidney injury in hospital admissions.

The overall mortality rate for emergency laparotomy is 15% and comes from the UK National Emergency Laparotomy Audit (NELA). There are also wide variations between hospitals. The objectives of this project is to determine the pattern of variance in the management and outcomes of   emergency surgery cases, accounting for over 10% of hospital admissions in the North-West of Ireland and internationally.

This research will involve systematic reviews and meta-analysis of variance in common surgical conditions. The focus will be on clinical care pathway redesign, personalised medicine, biomarkers and point-of-care (POC)  diagnostics for patients by the following steps:

(a) baseline data collection,

(b) data analysis  to identify clinical outcome determinants [including the role of novel biomarkers], clinical care pathway redesign [including the integration of POC diagnostics and decision support software] followed by

(c) prospective clinical evaluation  of the redesigned care pathway and

(d) translation to clinical and commercial utility.

The project will be highly interdisciplinary, combining the computational expertise at the ISRC at UU, extensive knowledge in biology at Northern Ireland Centre for Stratified Medicine, and the Emergency Surgery clinical expertise at Letterkenny University Hospital and Altnagelvin Hospital. In collaboration with our enterprise partners, we will develop an innovative decision support system incorporating a one-stop information platform (a cloud for storing, accessing and computing large datasets) and user friendly mobile apps to support POC diagnostics. Improved diagnostic accuracy, utilizing some or all of the identified clinical and biomarker parameters in the models developed, may allow redesign of care pathways. It is anticipated that this would translate into improved annual recorded observed Emergency Surgery mortality figures and cost reduction, as compared to expected figures based on local population demographics.

Successful outcomes of this project will be reported in peer-reviewed publications relating to current patterns in care, the effect of implementation of clinical pathways, data analytics and inter action into health services with industry collaboration to optimise patient outcomes. The scale of this work will be both in the North-West, nationally and internationally reducing time to definitive care, optimising diagnosis with point of care testing, streamlining processes to Emergency Surgery, reducing infection, morbidity and mortality, greater understanding of disease process and a transformation of one of the more neglected areas in medicine currently.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• A comprehensive and articulate personal statement

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• Relevant professional qualification and/or a Degree in a Health or Health related area

Funding and eligibility

The University offers the following levels of support:

Due consideration should be given to financing your studies. Further information on cost of living

This project is supported by the European Union's INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB).

This scholarship will cover tuition fees and a maintenance award of not less than £14,777 per annum for three years (subject to satisfactory academic performance). Applications are invited from UK, European Union and overseas students.