Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

• Published in: British journal of surgery 2015-01, Vol.102 (1), p.57-66
• Main Authors: Huddart, S., Peden, C. J., Swart, M., McCormick, B., Dickinson, M., Mohammed, M. A., Quiney, N.
• Format: Article
• Language: English
• Subjects: Aged; Emergencies; Emergency Treatment - mortality; Emergency Treatment - standards; Female; Hospital Mortality; Humans; Laparotomy - mortality; Laparotomy - standards; Male; Original; Patient Care Bundles - mortality; Patient Care Bundles - utilization; Quality Improvement - standards; Risk Assessment
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9658

Background Emergency laparotomies in the UK, USA and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence‐based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal‐directed fluid therapy and postoperative intensive care. Methods The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk‐adjusted mortality. Comparison of case mix‐adjusted 30‐day mortality rates before and after care‐bundle implementation was made using risk‐adjusted cumulative sum (CUSUM) plots and a logistic regression model. Results Risk‐adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6·47 in the baseline interval (299 patients included) to 12·44 after implementation (427 patients included) (P