Assurance of Surgical Quality; from the Trial to Clinical Practice

The assurance of surgical quality within randomised controlled trials has increasingly become a focus in the design and implementation stages of complex surgical trials. We have previously shown the importance of surgical quality assurance in reducing mortality and variation in lymph node harvest within surgical randomised controlled trials for oesophageal and gastric cancer. Typically as surgeons we measure harm from surgical interventions, as we introduce more technology to surgery the next step is to focus on intraoperative analysis to reduce patient harm before it occurs. Through ongoing development of observed clinical human reliability analysis (OCHRA) in several surgical specialties, we are developing the tools to quantify surgical performance. This in turn can reduce patient harm in departing from the tightly controlled randomised controlled trial environment to real life clinical practice. In this presentation we will explore the importance of surgical quality assurance, OCHRA, and future steps in improving the transition from clinical trials to clinical practice.