SP11.1 A co-ordinated approach to trainee quality improvement projects to reduce mortality and length of stay in patients undergoing emergency laparotomy

Abstract

Abstract Aim To support trainees in completing specific and achievable quality improvement projects (QIP) that are beneficial to patient care and aligned with clinical priority areas in emergency general surgery. Method A fishbone analysis of factors contributing to poor outcomes in patients undergoing emergency laparotomy was created. From this, key priorities for improvement were identified by a multidisciplinary team, enabling multiple QIP with clear aims to be developed. QIP included National Emergency Laparotomy Audit (NELA) data capture, risk scoring and documentation of mortality, identification and management of sepsis, pre-operative antibiotics, infection prevention and early radiological imaging. QIP were allocated to groups of trainees comprising of at least one foundation doctor, one core trainee and one specialty registrar. Mortality and length of stay data was collected over 6 months using the run charts for the hospital site available at data.nela.org. Results In 6 months, 9 QIP were started, with the first cycle of data collected in all projects and 3 projects completed by trainees. Initial QIP results have been presented locally for 5 projects and 2 QIP have been presented nationally, thus supporting completion of ARCP requirements and specialty job applications, as well as the sharing of outcomes. Although not statistically significant a downwards trend in length of stay and mortality has also been observed. Conclusion Having a focused and co-ordinated approach to quality improvement with clear aims and objectives can support training and improve patient outcomes. Further study is required to assess the sustainability and longevity of these results.