improving outcomes in emergency laparotomy
DESCRIPTION
Improving outcomes in emergency laparotomy Sam Huddart FRCA Clinical Research Fellow Department of Anaesthetics and Intensive Care Royal Surrey County Hospital, Guildford Presentation from Shaping the Future Direction of Enhanced Recovery Care Pathway Seven Days a Week workshop held in London on 5 December 2013TRANSCRIPT
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
• Health Foundation ‘Shine Award’. 2012• LiDCO: provided cards for CO monitor
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Sources of funding
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
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
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
27% reductionP= 0.1171
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
42% reductionP = 0.045
13Consecutive patient by operation date
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ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
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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
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
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
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle
Thank youNial Quiney & Matt Dickinson GuildfordCarol Peden BathMike Swart TorbayBruce McCormick Exeter
ELPQuiCELPQuiCEmergency Laparotomy Pathway Quality Improvement Care-Bundle