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Improving standards of care for patients undergoing bowel surgery

Posted: - 29th October 2019

More than 1,800 patients undergoing emergency bowel surgery have reduced their risk of post-operative complications, lengthy stays in hospital and death thanks to the improved standards of care promoted by our Emergency Laparotomy Collaborative (ELC) programme 

Around 30,000 patients undergo emergency laparotomy (bowel) surgery in England each year. However, around 15% of patients are reported to die within 30 days of surgery. Over 25% of patients remain in hospital for more than 20 days after surgery, costing the NHS over £200m a year.

The programme uses a Quality Improvement approach to reduce mortality rates, complications and length of stay, while encouraging a culture of collaboration and embedding QI skills to ensure sustainability of change.

This has involved the spread and adoption of the evidence-based Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle within the NHS trusts. The programme brings together staff within a trust and across Yorkshire and Humber’s acute trusts from emergency departments, radiology, acute admission units and surgical wards, theatres, anaesthetics and intensive care – with collaborative learning events, support interpreting the data and other networking activities supporting quality improvement initiatives in the Trusts.

Nationally the programme is active across all 15 Patient Safety collaboratives and there are 13 trusts in Yorkshire and Humber actively engaged in the regional programme

Key outcomes achieved to date include:

• It is estimated that 26,500 patients will have benefited from the work by March 2020.
• Initial results showed that the roll out of the care bundle successfully reduced average length of stay by 1.3 days and reduced crude in-hospital 30-day mortality rate by 11% when comparing baseline period with the improvement period. In Kent and Surrey Sussex alone, it is estimated that 79 lives were saved during the 24-month programme.
• A wider health economics analysis suggests every £1 spent will result in approximately £4.50 benefit to the wider health and social economy.

Each AHSN is following the same approach in terms of collecting data, peer support and sharing learning. However, which elements of the care bundle are delivered remain flexible, to allow for regional differences.

We commission the Improvement Academy to work with us to deliver the Patient Safety Improvement Programme.