Evaluation of the Collaborative Use of an Evidence-Based Care Bundle in Emergency Laparotomy

Abstract

Key Points Question Is a quality improvement collaborative approach to implementation of a care bundle associated with reductions in mortality from emergency laparotomy? Findings In this study of a collaborative project involving 28 hospitals and a total of 14 809 patients, reductions in mortality and length of stay were seen after implementation of a care bundle. Improvement took time to occur and was not seen until the second year of the collaborative project. Meaning The findings suggest that hospitals should consider adopting a care bundle approach and participating in a collaborative group to see improvement in outcomes for patients undergoing emergency laparotomy.

Sustaining better care for patients undergoing emergency laparotomy

“…Staff were supported to learn QI methodologies by attending the comprehensive trust QI programme, and to attend the Emergency Laparotomy Collaborative meetings .…”

Quality improvement and emergency laparotomy care: what have we learnt from recent major QI efforts?

“…It is perhaps notable that across all three initiatives, improving the time for getting emergency laparotomy patients into theatre has remained the most stubbornly challenging aspect of care to improve, suggesting that it may not amenable to improvement by QI methods alone. 2,6,7 Consideration of context goes beyond the structural aspects of an organisation. In the EPOCH trial, limited resources, both human and financial, and organisational upheaval were cited as key challenges by many interviewed in the process evaluation, as was lack of engagement of colleagues and hospital executives.…”

“…20,21 ELC was a large QI project funded by the Health Foundation, adopting implementation science to improve patient care. 7 The project was led by the Kent Surrey Sussex Academic Health Science Network ( www.kssahsn.net ) in 28 NHS hospitals, and used a quality improvement collaborative model to help teams to implement a laparotomy care bundle. Using statistical process control chart analysis, the ELC demonstrated an improvement in care-bundle compliance with a concurrent association with decreased 30-day mortality (to 8.3%) during the course of the ELC project.…”

Emergency laparotomy success – optimisation or triage?

“…However, the recent study by Peden et al, using a cluster randomised approach to quality improvement, did not show a significant change in mortality [10]. This could be due potentially to less actual improvement in key performance indicators, as compared with that seen in non‐randomised quality improvement programs [7, 10, 11]. In the Emergency Laparotomy Collaborative (ELC), focus was on: screening for sepsis and providing antibiotics within 1 hour; moving to the operating room within 6 hours of the decision to operate; consultant surgeon and anaesthetist in the operating room; goal‐directed fluid therapy; and ICU admission for all.…”