The Emergency Laparotomy Collaborative (ELC) started its implementation phase in September 2015.  The two-year quality improvement project is a collaborative project between West of England, Kent, Surrey and Sussex and Wessex AHSNs  with the aim of accelerating the spread of a care bundle that aims to improve standards of care for patients undergoing this surgery, reducing mortality rates, complications and length of stay in hospital. 

Great Western Hospitals (GWH) NHS Foundation Trust in Swindon is one of the six trusts represented across the West of England who have been doing some great work on improving the standards of care and outcomes for patients undergoing Emergency Laparotomy Surgery.

Malcolm Watters, Consultant in Anaesthesia and Intensive Care at the GWH tells us about their progress;

“Since the establishment of the National Emergency Laparotomy Audit (NELA) database we have been keen to improve the management and outcome of these patients at GWH.

The ELC has been an ideal way to promote six fundamental steps in the patient pathway that we can improve to make a difference. Starting with tackling early sepsis screening, recognition and treatment on the Surgical Assessment Unit, we have incorporated the screening tool in to the admission proforma and improved completion rates.

Secondly we have improved preoperative risk scoring by presentation of runcharts from the NELA data and encouraging surgeons and anaesthetists to use it to influence ongoing decision making such as Consultant presence in theatre and post op ICU. The easy way runcharts can be produced from NELA data is a real bonus in sharing successful improvement and rapidly communicating when performance drops off.

Most satisfying of all has been the policy of admitting Emergency Laparotomy (EL) patients to ICU. Almost 100% of our EL patients come to ICU and this practice is supported and encouraged by all from anaesthetists, ICU staff and bed managers alike. It is now embedded practice and the improvements we have seen in mortality is most welcome.

This would have been so much harder to achieve without the Collaborative events. As well as allowing comparison with your neighbours, the opportunity to network, share problems and collectively find solutions has been very rewarding and invaluable. The QI learning has also been really useful and we are sharing the tools learnt with other projects in my hospital another benefit of attending the Collaborative events.”

Figures just released show that the length of stay for those patients who survived to discharge has dropped by 1.9 days overall.

Other statistics from the ELC project show that:
• Overall care bundle adherence has risen from 61% during baseline to 70% in the first quarter (a 15.5% improvement)
• Time to surgery for the sickest patients (within 2 hours) has improved by 10% to 70.4% in the first quarter of the collaborative
• Consultant led care has also seen a 10% improvement to 74% in the first quarter of the collaborative
• 25% increase in the use of goal directed fluid therapy in West of England

Posted on September 5, 2016

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