• Project led by Royal Surrey County Hospital NHS Foundation Trust.
  • Focused on emergency laparotomy procedures at Royal Surrey College Hospital in Guildford, Royal United Hospital in Bath and Torbay Hospital in Torquay.
  • Aimed to improve patient outcomes after laparotomy.
  • Developed an evidence-based quality improvement care bundle which set out accepted standards of care for different aspects of emergency laparotomy care.

The Royal Surrey County Hospital NHS Foundation Trust developed an evidence-based quality improvement care bundle with the aim of improving patient outcomes after laparotomy.

The Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle set out accepted standards for:

  • prompt assessment, resuscitation and escalation of care
  • early use of antibiotics
  • early diagnostics and surgery within 6 hours of decision
  • goal-directed fluid therapy
  • intensive care.

The intervention was launched to staff with posters, emails and an education programme for those involved in caring for surgical patients, including surgeons, anaesthetists, intensivists, radiologists, and nursing and support staff.

The three trusts met at four project meetings over the 6-month assessment period, to share experiences of implementation and to address any locally-identified problems.

PINCER is also one of the Medicines Optimisation projects selected for national adoption and spread across the AHSN Network in 2018-2020.

Who was involved

The project manager was a clinical director and consultant in anaesthetics and the data manager was a clinical research fellow in anaesthesia.

A doctor at each of the three sites acted as clinical champion and was responsible for delivering the programme in each trust, including the administration of the bundle. The clinical champions also led local emergency laparotomy groups, which focused on optimising compliance.


  • 427 patients recruited over the study period.
  • 25% reduction in crude mortality rate.
  • Close to 35% reduction in crude mortality rate for the most high-risk patients.
  • 43% reduction in risk across all patients.


Some specific measures remained a challenge. This highlighted the need for continuous improvement and the development of locally-focused strategies.

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