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Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme
Deirdre M Nally1,2, Peter E Lonergan3,4,5, Emer P O'Connell6
1Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
Background:
Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.
Methods:
The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site.
Results:
The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0-11 per cent during the exploratory phase to 35-100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships.
Conclusions:
A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.
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