Emergency laparotomy

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A case study describing actions by Royal Surrey County Hospital NHS Foundation Trust to develop an evidence-based emergency laparotomy care bundle.

What is the emergency laparotomy programme?

Approximately 30,000 emergency laparotomies are performed annually with a mortality rate of about 15% within 30 days of surgery. The high average length of stay for these patients costs the NHS in England about £650 million per annum.

Royal Surrey County Hospital NHS Foundation Trust developed an evidence-based emergency laparotomy care bundle. This was implemented in four UK hospitals and data collected over eight months found crude 30-day mortality for all patients had dropped by 25% and risk-adjusted hospital mortality rate by 42%. This was one of seven projects selected for national adoption and spread across the AHSN network during 2015 and received scaling-up funding from The Health Foundation.

What the PSC did

The emergency laparotomy collaborative (ELC) programme uses quality improvement methodology to support the scaling-up of the ELC care bundle across the three AHSN regions (Kent Surrey Sussex, Wessex and West of England).

The PSCs have developed a suite of tools and delivered a training programme covering subjects such as plan–do–study–act (PDSA) cycles, process mapping and human factors.

The PSCs distribute a comparative dashboard showing adherence to the ELC care bundle and patient outcome measures on a quarterly basis. The hospital teams participating in the programme can use this data to improve quality of care and patient outcomes. Trusts also share their progress at collaborative learning events, enabling open dialogue, group reflection and celebration of success.

Impact

Impacts in the first year of the programme include:

  • 18% fall in risk-adjusted mortality rate
  • 8.5% fall in length of stay (1.5 days). This equates to a non cash-releasing saving of £1.3 million in the first nine months. An interim health economics assessment suggests that for every £1 spent, the wider health and social economy will benefit by about £4.50
  • 14.5% improvement in consultant-led care: a senior surgeon and anaesthetist are now present in theatre for four out of five patients
  • three-quarters of the sickest patients are now in theatre within two hours of the decision to operate.

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