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Title: Two-year outcomes from the Australian and New Zealand Emergency Laparotomy Audit-Quality Improvement pilot study.
Authors: Aitken, R James
Griffiths, Ben
Van Acker, Jill
O'Loughlin, Edmond
Fletcher, David
Treacy, John P
Watters, David
Babidge, Wendy J
Citation: © 2021 Royal Australasian College of Surgeons.
ANZ J Surg. 2021 Jun 28. doi: 10.1111/ans.17037.
Abstract: BACKGROUND: The aim of the Australian and New Zealand Emergency Laparotomy Audit-Quality Improvement (ANZELA-QI) pilot study was to determine (i) the outcomes of emergency laparotomy (EL) and (ii) the feasibility of a national, multi-disciplinary quality improvement (QI) project based on a bundle of evidence-based care standards. METHODS: An online database was created using the Research Electronic Data Capture (REDCap) programme. National ethics approval with waiver of consent was obtained. Data were entered directly onto REDCap and extracted monthly for eight care standards (preoperative consultant radiologist reporting of computed tomography scans, preoperative mortality risk score, consultant presence in theatre, timely access to theatre and critical care commensurate with risk and involvement of aged care). Monthly QI run charts using 'traffic' light graphics (green ≥80%, amber ≥50% to <80% and red <50%) reported compliance with the standards. RESULTS: Sixty hospitals indicated interest, but difficulties with site-specific ethics approval resulted in only 24 hospitals participating (2886 EL in 2755 patients). The overall in-hospital mortality was 7.1% (2.3%-13.3%) and average length of stay 15.5 (8.6-22.7) days. Both significantly declined. Preoperative risk assessment (overall 45%) improved almost three-fold during the study. Only 60% had timely access to theatre and only 70% with a predicted mortality risk of >10% were admitted to critical care. CONCLUSION: Overall mortality compared favourably with similar international studies and declined in association with participation in the audit. Compliance with some care standards shows considerable scope to improve EL care using QI methodology.
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Journal title: ANZ journal of surgery
Publication Date: 2021-06-28
Type: Journal Article
DOI: 10.1111/ans.17037
Orcid: 0000-0001-5653-6478
Appears in Collections:(a) NT Health Research Collection

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