• Led by Royal Surrey County Hospital NHS Foundation Trust, with evaluation by the University of Kent.
  • Being introduced in at least 24 acute care NHS trusts in England, spanning three Academic Health Science Networks.
  • Aiming to improve patient outcomes after emergency laparotomy through adoption of the ELPQuIC bundle.
  • Bundle includes early assessment and resuscitation, antibiotics for patients showing signs of sepsis, prompt diagnosis and early surgery, and post-operative intensive care for all.

Approximately 80,000 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 beds post-operatively and use of goal-directed fluid therapy.

The Emergency Laparotomy Pathway Quality Improvement Care (ELPQuIC) bundle has been developed and introduced into four hospitals to date. It aims to improve the standards of care for patients undergoing emergency laparotomy surgery, and reduce mortality rates, complications and hospital length of stay.

The bundle consists of: early assessment and resuscitation; antibiotics being administered to patients who show signs of sepsis; prompt diagnosis and early surgery; goal-directed fluid therapy in theatres and continued to intensive care units; and post-operative intensive care for all.

The project also includes making feedback on data on patients undergoing emergency laparotomy routine, and providing coaching to allow hospitals to better understand their data and develop solutions to the problems identified.

Results from the initial implementation of ELPQuIC have shown a reduction in risk-adjusted mortality of 42%. 

ELPQuIC will now be spread to at least 24 acute care NHS trusts in England, including hospitals from Kent across to Avon, spanning three Academic Health Science Networks.

Within each hospital the programme will be implemented widely. Emergency departments, acute admission units, radiology, theatres, anaesthetics and intensive care will all be directly involved