ThTP8.11 Team-Based Discussions to Improve Preoperative Protocol Adherence in NELA Patients: A Quality Improvement Project

Abstract

Abstract Aim To analyse the success of a quality improvement project (QIP) performed to improve emergency laparotomy outcomes in a tertiary hospital between NELA Year 7 and Year 8 (12/2019-11/2021). Methods NELA Year 7 results were presented at local meetings; following multi-disciplinary involvement, a PDSA cycle was initiated. A dedicated NELA team was established and NELA-related discussions at surgical and anaesthetic junior doctor inductions were implemented. Further, Pre-operative Care for Older People undergoing Surgery (POPS) staff were included at monthly morbidity-and-mortality meetings. We retrospectively analysed Year 7 results (156 cases) against Year 8 (162 cases) of NELA Annual Reports. Results Risk documentation before surgery significantly increased from 58% to 72%. Arrivals in theatre appropriate to urgency increased from 79% to 82.9%. Post-operatively, rates of unplanned admissions to critical care decreased by 40% in Year 7 relative to Year 8 (2%-1.2%). NELA mean patient length-of-stay (LOS) and risk-adjusted mortality rates were unchanged (26 days,5.5% respectively). Rates of unplanned returns to theatre increased (5%-6%). Conclusions This QIP displays the success of low-cost team-based interventions in significantly increasing adherence to preoperative protocol. We propose implementation of NELA-related discussion at GI-surgery trainee inductions nationally. Although successful, further changes must be considered to reduce LOS and mortality rates. NELA scores have since been incorporated into the WHO checklist and we plan to implement special discussions related to long-staying patients during ward round meetings, aiming to analyse the success of this PDSA cycle in Year 9.