COMS

Cardiac Output Monitoring Survey (COMS)

SPARC is proud to have participated in COMS. This survey of cardiac output monitoring was coordinated by the Research and Audit Federation for Trainees (RAFT) across 90 acute trusts within the network.

 

Background

Cardiac Output Monitors (COMs) are marketed as a means of individualising haemodynamic therapy in the peri-operative period. The National pre-requisite Commissioning for QUality and Innovation (CQUIN) payment schemes [1], the NHS Technology Adoption Centre [2] and recent National Institute for Health and Care Excellence (NICE) technology recommendations [3, 4] have all been produced to incentivise and drive implementation of this technology.

This survey aimed to describe the type of COMs used in UK anaesthetic practice, and determine the effects the NICE guidance and the national CQUIN scheme have had on the uptake of this technology and its implementation.

Objectives

1. Describe the current COM availability

2. Determine the effect of CQUIN payment schemes and NICE guidance in driving COM implementation

COMS organisation

COMS is facilitated by the RAFT committee and recruits through all the current regional anaesthetic trainee collaboratives within England and Wales.

The project is to be run by the RAFT committee with local named regional leads from each group. These regional leads will identify a named local trust investigator at each of the local sites within their own network. It will be these local trust investigators that will collect data for this ‘snap’ survey.

Data Collection

Data collection occurred during a ‘hot’ week in July (2014). This includes:

1. COMS types & numbers

2. Availability of local COMS guidelines & protocols

3. Equipment procurement

Project data governance

In the harmonised research ethics guidance (GafREC), surveys of NHS staff are regarded as exempt from research ethics approval [5]. This survey is an enquiry that doesn’t involve patients or patient data.

Confirmation has been received from the Health Services Research Centre of the National Institute of Academic Anaesthesia that as a survey / service evaluation, COMS data may be collected and centralised using ‘low security’ systems. A recent nationwide survey of outcome reporting was conducted by the HSRC, NIAA through the national QuARC (Quality Audit and Research Coordinators) according to exactly these principles.

Data analysis

Data will be analysed by RAFT ‘data analysis’ team. Data will undergo simple quantitative descriptional statistical analysis.

Result dissemination

Results will be disseminated through regional and local trust presentations (regional meetings, local departmental audit meetings).

Abstracts will be submitted to national anaesthetic meetings (Anaesthetic Research Society)

A manuscript will be prepared and submitted for publication in a relevant peer-reviewed journal

Authorship rules

As per RAFT governance rules all presentations and publications made in name of RAFT. All contributors to project will be recognised and cited in any peer-reviewed publications.

References

1. http://www.england.nhs.uk/wp-content/uploads/2013/02/cquin-guidance.pdf (accessed 30/7/2014)

2. http://webarchive.nationalarchives.gov.uk/20130701143131/http:/ntac.nhs.uk/web/ files/intra_operative_fluid_management/iofm_adoption_pack_update_jan_2013.pdf (accessed 30/7/2014)

3. NICE (2011) CardioQ-ODM (oesophageal Doppler monitor) (MTG3) accessed at www.nice.org/guidance/mtg3 (accessed 30/7/2014)

4. NICE (2012) Oesophageal Doppler-guided fluid management during major surgery: reducing post-operative complications and bed days. Accessed at http:// arms.evidence.nhs.uk/resources/qipp/645122/attchment (accessed 30/7/2014)

5. Governance arrangements for research ethics committees: a harmonised edition (updated April 2012) https://www.gov.uk/government/publications/health-researchethics- committees-governance-arrangements (accessed 30/7/2014)

 

Regional Trust Project Lead

Dr Ben Harris

Local Trust Project Lead

Basingstoke
Dorchester
Poole
Dr Phil McGlonePortsmouth
Dr Ilana Delroy-Buelles
Dr Christian Schopflin
Salisbury
Southampton
Winchester