SP 6.01 A Human-Factor Intervention Bundle to Improve Rescue Efforts for Post Operative Deteriorating Emergency Surgery Patients – A Pilot Study Using Quality Improvement Approach
Hamza Waqar Bhatti, Olivia Lounsbury, Mudathir Ibrahim, Saydia Wesley, William Drew Plath, Peter McCullochAbstract
Introduction
The mortality of emergency laparotomy is decreasing, but remains high. The rescue process for patients deteriorating after emergency surgery is a complex team activity highly prone to error and delay. Human factors interventions are a rational approach to improving the speed and quality of rescue. We used a Human Factors/Quality Improvement approach to design a bundle of HF interventions and embed them in local practice in emergency general surgery units.
Methods
In a three-hospital study, we tested 4 human factors interventions (patient involvement, team strengthening, standardized communication protocols, and emergency process algorithms for all staff) designed to reduce response times for acutely deteriorating postoperative emergency abdominal surgery patients. We used quality improvement methodology to iteratively enhance the interventions during this pilot study for a proposed randomized trial (RESPOND). We measured response times before, during, and after a 8-month implementation period
Results
Our preliminary results showed a 40% significant reduction of median response time from 259 minutes (n=83) pre-intervention to 155 minutes (n=70) during intervention to 154 minutes (n=77) post intervention across three sites combined (p=0.014). Each of the 4 strands was modified several times in response to QI feedback. Each of the 4 strands was modified several times in response to QI feedback.
Conclusion
A bundled human factor-based intervention substantially improved response times for emergency surgery patients with serious postoperative complications. A QI approach to iterative optimization of interventions promotes higher uptake. These results justify a randomized trial of the intervention to determine whether it can reduce mortality.