Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

30 August 2018


Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy


S Huddart, C J Peden, M Swart, B McCormick, M A Mohammed, N Quiney, ELPQuiC Collaborator Group

Published journal

British Journal of Surgery


Background: Emergency laparotomies in the UK, USA and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence-based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal-directed fluid therapy and postoperative intensive care.

Methods: The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of case mix-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model.

Results: Risk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6·47 in the baseline interval (299 patients included) to 12·44 after implementation (427 patients included) (P < 0·001). The overall case mix-adjusted risk of death decreased from 15·6 to 9·6 per cent (risk ratio 0·614, 95 per cent c.i. 0·451 to 0·836; P = 0·002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient case-mix profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity risk (0·197 and 0·223 before and after implementation respectively; P = 0·395).

Conclusion: Use of the ELPQuiC bundle was associated with a significant reduction in the risk of death following emergency laparotomy.

Related links

You might also like...

Press release

NHS facing uphill battle

OnlyWan response to NHS England monthly statistics for August and September 2019.

Press release

New funding for diagnostic equipment falls considerably below what is needed

OnlyWan response to the Prime Minister’s announcement of funding for cancer screening.


A combined effort for autism: lessons from the community for the health system

Research shows 88% of autistic people do not think their needs are understood by health professionals. Emily Niner and Oliver...


Huddart, S., Peden, C. J., Swart, M., McCormick, B., Dickinson, M., Mohammed, M. A., Quiney, N., the ELPQuiC Collaborator Group (2015), Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg, 102: 57–66. doi: 10.1002/bjs.9658
Kjell-bubble-diagramArtboard 101 copy -

Get social


Wondering how to get started with your #QualityImprovement project? Read an article in our #QI series with…

Kjell-bubble-diagramArtboard 101 -

Work with us

We look for talented and passionate individuals as everyone at the OnlyWan has an important role to play.

View current vacancies
Artboard 101 copy 2 -

The Q Community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more