Sustaining better care for patients undergoing emergency laparotomy

Area of Science:

• Surgical Quality Improvement
• Patient Safety
• Healthcare Management

Background:

• Emergency laparotomy carries a high mortality risk.
• Evidence-based care bundles can improve outcomes for these high-risk patients.
• Sustaining improvements after initial implementation can be challenging.

Purpose of the Study:

• To re-implement and assess the impact of a six-component care bundle for emergency laparotomy.
• To evaluate changes in patient outcomes and care bundle compliance.
• To identify factors influencing the sustainability of quality improvement initiatives.

Main Methods:

• A quality improvement project involving 27 hospitals in the Emergency Laparotomy Collaborative.
• Re-implementation of a six-component care bundle following a period of deterioration.
• Analysis of a cohort of 930 patients undergoing emergency laparotomy, comparing baseline data with post-implementation data.

Main Results:

• Thirty-day mortality decreased from 11% to 7.3%.
• Average hospital length of stay reduced from 19.5 to 17.9 days.
• Full care bundle compliance increased from under 60% to over 80%.

Conclusions:

• Re-implementation of an evidence-based care bundle improves outcomes for emergency laparotomy patients.
• Sustained compliance with care bundles is essential for maintaining improvements.
• Addressing sustainability challenges from the outset is critical for quality improvement projects.