Barriers and Enablers of Equity in Enhanced Perioperative Care (BEE-EPC)

The BEE-EPC (Barriers to Equitable Enhanced Perioperative Care) project is an observational study designed to explore the reasons behind the absence of enhanced perioperative care (EPC) services in nearly half of NHS hospitals in England. While structural data from sources such as the Faculty of Intensive Care Medicine (FICM) survey suggest that 55% of hospitals have some form of EPC provision, there remains a significant knowledge gap about the 45% that do not. This project seeks to address that gap by focusing specifically on these sites.

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BEE-EPC complements interventional work in the HIPPOCRATES programme and runs alongside, though remains distinct from, national initiatives such as NHS England’s critical care stocktake and the REPACC study. It aims to identify and characterise discrepancies in EPC provision based on geography, organisational structure, and patient demographics. Sampling strategies will be informed by existing datasets (e.g. FICM and REPACC) to ensure maximum relevance and variation.

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The study employs a mixed-methods design. Closed survey questions will be used for quantitative analysis, while open-ended responses will be examined using Structural Topic Modelling (STM), a form of machine-assisted topic analysis (MATA). STM is particularly suited for analysing large volumes of short, free-text responses and enables stratification by metadata such as hospital type or patient population. This hybrid approach leverages both human insight and machine learning, supporting a ‘big qualitative’ methodology that can uncover nuanced, intersectional barriers—particularly those linked to deprivation.

Lead Investigator

Adam Hunt