Abstract
BackgroundAcute gallstone disease is a high‐volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance.MethodsPatients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole‐QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods.ResultsOf 13 sites invited to join Chole‐QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole‐QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8‐day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals.ConclusionA surgeon‐led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy.
Highlights
Gallstone-related disease accounts for approximately one-third of emergency general surgery admissions and referrals[1]
National guidance from the UK National Institute for Health and Care Excellence (NICE) is for laparoscopic cholecystectomy to be done within 7 days of a diagnosis of acute cholecystitis, and within the index admission for pancreatitis[5]
The aim of the collaborative was to demonstrate that time to emergency cholecystectomy could be reduced for eligible patients with acute biliary pain, cholecystitis or gallstone pancreatitis, by using quality improvement (QI) methodologies to enable clinicians to drive change within their own institutions
Summary
Gallstone-related disease accounts for approximately one-third of emergency general surgery admissions and referrals[1]. Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). At the individual site level, eight of the 12 Chole-QuIC sites showed a significant improvement (P < 0⋅050), with four sites increasing their 8-day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15⋅3 per cent for control hospitals. Conclusion: A surgeon-led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy
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