Emergency laparotomy is a major surgical procedure, with 30,000 to 50,000 performed every year in the UK. However, around 15% 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. The Collaborative brought together 28 hospitals and 24 NHS trusts across three AHSN regions: Kent Surrey Sussex; Wessex; and West of England.
The Collaborative worked to improve standards of care for patients undergoing emergency laparotomy surgery, reduce mortality rates, complications and hospital length of stay, while encouraging a culture of collaboration and embedding QI skills to ensure sustainability of change.
This involved the spread and adoption of the evidence-based Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle within the NHS trusts. The programme has brought together dozens of staff at collaborative learning events from across the trusts – from emergency departments, radiology, acute admission units, theatres, anaesthetics and intensive care.
Through roll-out of the care bundle across 28 hospitals, the project successfully reduced lengths of hospital stay by an average of 1.3 days, and crude mortality rates have fallen by 11%. In Kent Surrey Sussex alone, it is estimated that 66 lives have been saved since the project began.
A health economics analysis suggests every £1 spent will result in approximately £4.50 benefit to the wider health and social economy.
All AHSNs committed to supporting trusts in their regions to implement the Emergency Laparotomy Collaborative care bundle from 2018 to 2020.