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. 2022 Jul 7;6(4):zrac092.
doi: 10.1093/bjsopen/zrac092.

Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme

Deirdre M Nally  1   2 , Peter E Lonergan  3   4   5 , Emer P O'Connell  6 , Deborah A McNamara  3   6 ; SURGical Improvement Network (SURGIN)
Collaborators, Affiliations

Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme

Deirdre M Nally et al. BJS Open. .

Abstract

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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Figures

Fig. 1
Fig. 1
Programme statistical process chart
Fig. 2
Fig. 2
The rate of patients with a recorded preoperative risk score before emergency laparotomy according to study site factors
Fig. 3
Fig. 3
Temporal relationship of risk score performance and volume of mobile instant messaging per month
Fig. 4
Fig. 4
Importance of programme interventions ranked by participants
See this image and copyright information in PMC

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