improving outcomes in emergency laparotomy
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Improving outcomes in emergency laparotomySam Huddart FRCAClinical Research Fellow
Department of Anaesthetics and Intensive CareRoyal Surrey County Hospital, Guildford
ELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
The Holy Grail of enhanced recovery?
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Emergency ERAS
• Health Foundation ‘Shine Award’. 2012• LiDCO: provided cards for CO monitor
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Sources of funding
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Key Points• Multicentre QI collaboration• Existing baseline data for benchmarking• Board-level buy-in before starting• Regular local and project meetings• Multidisciplinary • Locally driven QI strategies• Data collection Dec ‘12 – July ‘13
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
27% reductionP= 0.1171
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
42% reductionP = 0.045
13Consecutive patient by operation date
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Site 3
Site 1
Site 2
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
p=0.1463
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Site 1 Site 2 Site 3 Site 4
MEWS 65% 78% 99% 99%
Pre-op antibiotics 53% 69% 65% 86%
Theatre <6 hours 77% 62% 66% 74%
Intra-op GDFT 92% 58% 82% 49%
ICU post op 95% 56% 75% 62%
Summary of ELPQuiC• Change is difficult!
– Attitudes and behaviour– Heterogeneous population– Multidisciplinary– Acute Care Provision
• Improvements in metrics• Improvements in outcomes• Huge potential for further improvements
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
The future• National Emergency Laparotomy Audit
– http://www.nela.org.uk/
• EPOCH trial– Randomised cluster trial– QI for emergency laparotomy– http://www.epochtrial.org/epoch.php
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Thank youNial Quiney & Matt Dickinson GuildfordCarol Peden BathMike Swart TorbayBruce McCormick Exeter
samhuddart@nhs.net
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
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