Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy. Issue 6 (8th October 2019)

• Record Type: Journal Article
• Authors: Bamber, J R; Stephens, T J; Cromwell, D A; Duncan, E; Martin, G P; Quiney, N F; Abercrombie, J F; Beckingham, I J; Abraham, J; Ahmad, I; Ahmed, J; Andrews, M; Appleton, B; Asif, M; Bolton, R; Briggs, C; Bumagat, U; Burchfield, S; Cochrane, G; Dewi, F; Dovell, G; Dyer, S; Edge, J; Edwards, R; Fabre, I; Gemmill, E; Griffiths, E; Hariharan, D; Harrington-Patel, E; Hassn, A; Hepworth, M; Hewes, J; Hine, S; Hollyman, M; Ide, K; Jenner, D; Johnson, R; Jordan, S; Karamanakos, S; Kovoor, J; Kukreja, N; Marangoni, G; Metcalfe, N; Morcous, P; Needham, P; Patel, N; Qureshi, N; Rajaretnam, N; Rajendran, I; Sabah, Y; Sanders, D L; Sandison, A; Sansom, J; Seth, R; Shetty, V; Sollei, T; Strong, S; Sullivan, L; Sutcliffe, R P; Talbot, L; Taylor, G; Varadarajan, V; Villatoro, E; Wardale, J; Weaver, S; Wiggins, T; Wood, A;
• Is Part Of: BJS open. Volume 3:Issue 6(2019)
• Page Start: 802
• Page End: 811
• Publication Date: 2019-10-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50221
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance. Methods: Patients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods. Results: Of 13 sites invited to join Chole-QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement ( P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole-QuIC sites showed a significant improvement ( P < 0·050), with four sites increasing their 8-day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals. Conclusion: A surgeon-led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy. Graphical Abstract: Evaluation was undertaken to determine whether a 12-hospital quality improvement collaborative could be effective in assisting surgeons to implement national guidance to improve the care pathway for patients with acute gallstone disease. A negative binomial regression model showed a significant improvement in the 8-day surgery rate for participating hospitals (in line with national guidance), above any national trend of all English and Welsh hospitals. A surgeon-led quality improvement collaborative approach is effective at improving care for patients requiring emergency cholecystectomy. Evidence of the value of a quality improvement programme