Reducing mortality rates and improving patient care in emergency laparotomy surgical procedures

Emergency laparotomy is a major surgical procedure, but around 15% of patients are reported to die within 30 days of the surgery. Patients also regularly remain in hospital for a long time after surgery. The Emergency Laparotomy Collaborative (ELC), which brought together hospitals and NHS trusts, fostered a culture of collaboration and quality improvement skills to ensure to improve standards of care for patients undergoing the procedure.

Funded by the Health Foundation, the Emergency Laparotomy Collaborative (ELC) was originally established in 2015 to use a quality improvement (QI) approach to create a long-term sustainable improvement. 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).