Emergency Laparotomy Collaborative (ELC): improving outcomes after emergency laparotomy Royal Surrey County Hospital NHS Foundation Trust

Approximately 30,000 patients undergo emergency laparotomy each year in the NHS. It is a high-risk type of surgery, with prolonged lengths of stay and high mortality rates. Mortality rates vary widely between hospitals and there are wide variations between hospitals in quality metrics such as seniority of staff present during surgery, use of critical care beds post-operatively and use of goal-directed fluid therapy.

The Emergency Laparotomy Collaborative (ELC) quality improvement programme aims to improve standards of care for patients undergoing emergency laparotomy surgery, and reduce mortality rates, complications and length of hospital stay. A care bundle that was used in the Emergency Laparotomy Pathway Quality Improvement project was used. 

The ELC care bundle includes: screening the patient for signs of deterioration; screening for sepsis and timely administration of antibiotics; transfer to theatre within six hours of the decision to operate; the use of intra-operative goal directed fluid therapy; and post-operative intensive care for all patients with consultant involvement throughout.

The programme has been rolled out to 28 hospitals, spanning the area covered by three Academic Health Science Networks: Kent Surrey Sussex, West of England and Wessex. 

Evidence of improvement took time, but significant improvements in recognised quality standards of care were seen in the second year of the collaborative. 

There were 5,562 patients in the baseline group and 9,247 patients in the implementation group. Unadjusted mortality fell from baseline of 9.8% to 8.3% in the second year of the project, and risk adjusted mortality from baseline of 5.3% to 4.5%. Mean length of stay reduced from 20.1 days to 18.9 days. Significant changes in five out of six items in the care bundle delivery were achieved.

The project has been shortlisted in the ‘Innovation in Quality Improvement’ category for the BMJ Awards 2019.