Improving care for patients undergoing emergency laparotomy surgery

This week is Patient Safety Awareness Week, and the coronavirus crisis currently facing the NHS reminds us of the importance of continually driving improvements in patient safety, and providing NHS staff with the necessary space and support to cope with adversity and lead these improvements.

UCLPartners delivers a range of patient safety initiatives, through locally-initiated programmes like our Invasive Procedures Safety Network, and by contributing to national efforts including the Patient Safety Improvement Programme and the Emergency Laparotomy Collaborative – a programme to support improvements in outcomes for patients undergoing emergency abdominal surgery.

Emergency abdominal surgery is common, with over 30,000 patients having this type of surgery every year. 1 in 12 of these procedures takes place in a UCLPartners hospital. Over the last five years, there have been national efforts to improve clinical outcomes for these patients after they were identified as a high-risk group, with one in 10 not surviving at 90 days after their surgery.

The reasons for their poor outcomes are multifactorial and include patient, organisational and societal factors. Many patients undergoing an emergency laparotomy are elderly, with multiple co-morbidities, often presenting with severe sepsis and organ dysfunction.

Using local data, we have helped individual trusts design bespoke local QI solutions to overcome barriers to improvement and to share successes with partners across the network.

Organisational factors are measured against a set of national standards using the National Emergency Laparotomy Audit. This valuable data set is fed back to organisations enabling them to use it to drive local improvement. This is where the UCLPartners Emergency Laparotomy Collaborative has proved particularly helpful for partner organisations. Using local data, we have helped individual trusts design bespoke local QI solutions to overcome local barriers to improvement and to share local successes with partners across the network.

Recent research from a UCL group, however, has shown that despite national improvements in organisational factors and overall care, there still remains a disparity in outcomes that is linked to deprivation around the country, with clear differences in survival after emergency abdominal surgery in different socioeconomic areas.

Outcomes after emergency laparotomy have steadily improved since the launch of NELA and programmes like the Emergency Laparotomy Collaborative, but future work in this area, and in patient safety more widely, must recognise that improvements in outcomes must not disproportionately favour the better off and instead make every effort to target the most disadvantaged in society.