1309 A Quality Improvement Project on Small Bowel Obstruction Operative Mortality Rate

Aim

Higher than average emergency laparotomy mortality rates had been identified via the National Emergency Laparotomy Audit (NELA), at a particular hospital. Small bowel obstruction (SBO) is the commonest cause for emergency laparotomy. The aim of this project was to evaluate the management of SBO, and to implement changes to reduce the operative SBO mortality rate.

Method

NELA was used to assess emergency laparotomy cases between 1st Dec 2018 - 30th Nov 2019; (n = 198), of which there were 24 mortalities. The dataset was filtered for SBO (n = 87), of which there were 12 mortalities. The clinical management of these 12 SBO mortality cases were analysed and compared to the latest ASGBI and NCEPOD recommendations on SBO management.

Following this review, a systematic change in the management of SBO was introduced with the aim of reducing time to operation, appropriate candidate selection and avoiding drifting in management. This consisted of producing a SBO management flowchart as well as ensuring allocation of theatre slot within 72 hours for patients suitable for operation.

Results

Following the intervention, we assessed cases between 1st April 2021 - 31st March 2022 (n = 152), of which there were 13 mortalities. The dataset was filtered for SBO cases (n = 57), of which there were 3 mortalities. Emergency laparotomy mortality rate reduced from 12% to 9%. SBO operative mortality rate reduced from 14% to 5%. Emergency laparotomy deaths relating to SBO reduced from 50% to 23%.

Conclusions

The intervention resulted in improvement in SBO operative mortality rates as well as overall emergency laparotomy mortality rates.