Evaluation of the Emergency Laparotomy Collaborative programme

• Research type

  Research Study

• Full title

  Evaluation of the Emergency Laparotomy Collaborative (ELC) Quality Improvement project: Improving outcomes after emergency laparotomy.

• IRAS ID

  193034

• Contact name

  Stephen Peckham

• Contact email

  S.Peckham@kent.ac.uk

• Sponsor organisation

  University of Kent

• Duration of Study in the UK

  1 years, 11 months, 31 days

• Research summary

  The evaluation will study the outcomes and processes of the 2-year Emergency Laparotomy Collaborative (ELC) quality improvement programme. A post-operative care pathway (ELPQuIC) was developed and piloted in four hospitals in 2012. The pathway was developed to improve patient outcomes following emergency abdominal surgery as it is a high-risk surgical procedure with a 30-day mortality of 15% which rises to 24% in patients over 80 years of age. Other associated outcomes are post-operative complications and longer stays in hospital. Significant variations in standards of care have also been reported. The pilot showed improvements in key standards of care with a 25% reduction in the 30-day mortality in all patients.
  The ELC programme will roll out a simplified version of this postoperative pathway into 30 hospitals in three regions – Kent Surrey Sussex, West of England and Wessex. It involves using quality improvement techniques such as education, data collection and data sharing as well as encouraging regional collaborations. The amended pathway has five elements: early assessment and resuscitation; antibiotics administered to patients who show signs of infection; prompt diagnosis and early surgery; goal-directed fluid therapy in theatres and continued to intensive care; and post-operative intensive care for all.

  We seek approval for the ELC evaluation, which is a separate and independent part of the overall programme. The evaluation aims are to assess how the pathway was adopted and the costs involved in delivering it, describe how the hospitals learn and share practice together, examine whether outcomes have improved and if there have been any changes in practice. The outcome evaluation includes an analysis of anonymised data from the National Emergency Laparotomy Audit [NELA] database
  [http://www.nela.org.uk/]. The process evaluation will use qualitative interviews with hospital staff from approx. 12 selected case study sites across the three regions and observations of the regional meetings and training events.

• REC name

  N/A

• REC reference

  N/A