AHSN Network national programme from April 2018-March 2020

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 (ELC) was originally established in 2015 to use a quality improvement (QI) approach to tackle this. The ELC brought together 28 hospitals and 24 NHS trusts across three AHSN regions: Kent Surrey Sussex; Wessex; and West of England.

The ELC 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.

Through the initial 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 decreased by 11%.

A health economics analysis suggested every £1 spent results in approximately £4.50 benefit to the wider health and social economy.

This evidence supported the selection of this intervention as an AHSN Network national programme between April 2018-March 2020. All AHSNs committed to supporting trusts in their regions to implement the Emergency Laparotomy Collaborative care bundle.

At the end of the AHSN Network national programme 97% of eligible sites had adopted the bundle and more than 50,000 patients benefited over the course of the programme (figures from April 2018-March 2021).

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