The programme

This programme seeks to support acute trusts to improve standards of care for patients undergoing emergency laparotomy surgery by the spread and adoption of the evidence-based Emergency Laparotomy Pathway Quality Improvement (ELPQuiC)  bundle.

The programme brings together staff within a trust and across Yorkshire and Humber’s acute trusts from emergency departments, radiology, acute admission units and surgical wards, theatres, anaesthetics and intensive care – with collaborative learning events and other networking activities.

Why

Emergency laparotomy is a major surgical procedure, with 30,000-50,000 performed annually in the UK. However 14.9% of patients are reported to die within 30 days of surgery. Over 25% of patients remain in hospital for more than 20 days after surgery, costing the NHS over £200m a year.

Funded by the Health Foundation, the Emergency Laparotomy Collaborative was established in 2015 to use a quality improvement (QI) approach to tackle this.

Impact to date

Nationally the programme is active across 28 hospitals – 24 NHS Trusts – within three AHSN regions.

Initial results show that the roll out of the care bundle successfully reduced average length of stay by 1.3 days and reduced crude in-hospital 30-day mortality rate by 11% when comparing baseline period with improvement period. In Kent and Surrey Sussex alone, it is estimated that 79 lives were saved during the 24 month programme.

Key outcomes achieved to date include:

  • A fall in the risk adjusted mortality rate by 18% in just three months, and length of stay fell by 8.5% (1.5 days)
  • Over 98% of patients (+4,000) who had an emergency laparotomy received at least one aspect of the care at a participating hospital between 1st October 2015 and 20th September 2016
  • Consultant-led care has improved by 14.5% meaning four out of five patients now have a senior surgeon and anaesthetist present in theatre
  • A wider health economics analysis suggests every £1 spent will result in approximately £4.50 benefit to the wider health and social economy