Download - Improving outcomes in emergency laparotomy

Improving outcomes in emergency laparotomySam Huddart FRCAClinical Research Fellow

Department of Anaesthetics and Intensive CareRoyal Surrey County Hospital, Guildford

ELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle

The Holy Grail of enhanced recovery?

ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle

Emergency ERAS

http://www.google.co.uk/url?q=http://www.crystalinks.com/holygrail.html&sa=U&ei=LYyfUu-iHYOVhQe37IDwCA&ved=0CDoQ9QEwCA&usg=AFQjCNGp9t8SEARj4Y00v_VKh2GYqwipWw

• Health Foundation ‘Shine Award’. 2012• LiDCO: provided cards for CO monitor


Sources of funding

Key Points• Multicentre QI collaboration• Existing baseline data for benchmarking• Board-level buy-in before starting• Regular local and project meetings• Multidisciplinary • Locally driven QI strategies• Data collection Dec ‘12 – July ‘13



27% reductionP= 0.1171


42% reductionP = 0.045

13Consecutive patient by operation date

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Site 3

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Site 2


p=0.1463

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Site 1 Site 2 Site 3 Site 4

MEWS 65% 78% 99% 99%

Pre-op antibiotics 53% 69% 65% 86%

Theatre <6 hours 77% 62% 66% 74%

Intra-op GDFT 92% 58% 82% 49%

ICU post op 95% 56% 75% 62%

Summary of ELPQuiC• Change is difficult!

– Attitudes and behaviour– Heterogeneous population– Multidisciplinary– Acute Care Provision

• Improvements in metrics• Improvements in outcomes• Huge potential for further improvements


The future• National Emergency Laparotomy Audit

– http://www.nela.org.uk/

• EPOCH trial– Randomised cluster trial– QI for emergency laparotomy– http://www.epochtrial.org/epoch.php


http://www.nela.org.uk/

http://www.epochtrial.org/epoch.php

http://www.nela.org.uk/NELA_home

Thank youNial Quiney & Matt Dickinson GuildfordCarol Peden BathMike Swart TorbayBruce McCormick Exeter

[email protected]


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