The Clinical Effectiveness Unit (CEU) was established in March 1998 as an academic collaboration with the Health Services Research Unit of the London School of Hygiene and Tropical Medicine (LSHTM).
In 1990, the Royal College of Surgeons of England (RCS) established the Surgical Epidemiology and Audit Unit, funded by the Department of Health, to undertake clinical audit projects and to measure patient satisfaction with surgical services.
An external review of the Unit's activities carried out in 1996 recommended the creation of an academic link with a local university. As a result, the Clinical Effectiveness Unit (CEU) was established in March 1998 as an academic collaboration with the Health Services Research Unit of the London School of Hygiene and Tropical Medicine (LSHTM).
The original objectives of the CEU were to develop audit methodologies, to carry out national surgical audits, and to produce evidence on clinical and cost effectiveness. Since April 2001, the CEU is also involved in the development of clinical guidelines through its input in the National Collaborative Centre for Acute Care that is hosted by the RCS.
Since its inception in 1998, the CEU has become a national centre of expertise in methods, organisation, and logistics of large-scale studies of the quality of surgical care.
It has fostered collaborative links with professional organisations and other relevant bodies within the NHS, the Department of Health, and the Healthcare Commission. The CEU is assisted and advised by the Clinical Effectiveness Committee which comprises members of the RCS Council, surgeons representing the main subspecialties, and senior academics with relevant expertise.
Its research has directly influenced clinical policy as well as audit practice in the UK. Most of the work of the CEU takes place within multidisciplinary collaborations. For many projects, a CEU staff member is the principal or co-principal investigator alongside senior clinicians and as such responsible for project design, analysis and interpretation.
CEU staff work closely with colleagues at the Office for Research and Clinical Audit (ORCA), the 'sister unit' of the CEU at the Royal College of Obstetricians and Gynaecologists. To strengthen this link, the Director of the CEU will also act as Honorary Director of ORCA.
The CEU has also developed a successful short-course programme mainly aimed at trainee and senior surgeons who are interested in patient-oriented surgical research or want to strengthen the scientific basis of their practice. In total, these courses had more than 500 participants whose evaluations have been very positive. Furthermore, in total, 15 trainee surgeons have carried out research projects within the CEU since 2002, supported and supervised by CEU staff members.
Strategy for involvement
The CEU has developed a strategy for its involvement in national audit projects. An essential element of this strategy is that it considers audit projects as epidemiological studies of the quality of surgical care.
This implies that epidemiological methods should be used to generate high quality quantitative evidence on the processes and outcomes of surgical care as well as on their determinants.
The methodological requirements of CEU's audit projects do not differ from those of any epidemiological study: (1) representative sample of patients, (2) unbiased measures of processes, outcomes and their determinants, and (3) appropriate methods of analysis.
The single most important factor to produce high quality evidence on the quality of surgical care is therefore the collection of data that is unbiased, complete and accurate. As a consequence, data validation procedures need be to be carried out at various stages of the data management process.
The next five years
For the next 5 years, the CEU has three specific objectives.
First, it intends to develop the portfolio of large-scale national projects. The extent and nature of the involvement of the CEU in these projects may vary from full responsibility for the entire project to a contribution to one or more components.
Second, the CEU aims to strengthen its methodological work within the context of these large-scale projects. This work will address risk adjustment, methods for efficient data collection (eg paper patients), continuous outcome monitoring, value of existing databases for audit and research (both administrative and clinical data), and the impact of national audits on the quality of care.
Third, the teaching in research methods and evidence-based surgery will gradually be extended. In the short-term, we will develop new courses (eg a course on data collection methods and base development). In the medium to long term, we envisage a set of web-based distance learning modules that can be taken by participants anywhere in the world, but with a special attention to surgeons and other healthcare professionals in the developing world.