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

This study describes the structure and delivery of a successful quality improvement programme to increase the use of perioperative risk scoring in emergency laparotomy. This project illustrates how an active implementation framework can be applied to quality improvement projects in surgical care and the contextual considerations surrounding the same. It demonstrates how trainees/residents are appropriately placed to develop networks and deliver national-level quality improvement. 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.