SP 9.13 Use of National and Local NELA Data for Quality Improvement of EGS Pathways Allows Calculation of Required Provision of CT Capacity for A “Straight to Test” (STT) CT Pathway for Potential Emergency Laparotomy (EL) Patients Presenting in The E

Aims

We previously shown failure to identify patients requiring EL triples predicted mortality from first presentation and that an STT CT protocol is possible. National guidelines suggest assessment of EL patients by senior surgeons. NELA annual reports have shown that 1 in 5 EL patients are not referred to EGS from ED. We aimed to estimate the required number of abdominal CT scans needed per day to pick up all the potential adult patients requiring EL by STT CT.

Methods

Audit 1-week EGS admissions from ED (establish practice and which patients required EGS admission and which did not). Audit 2-weeks ED patients with GI code (assess number of potential STT CT pts). Using those characteristics with NELA data, drew up a pathway and audited two separate 7-day periods to assess pathway validity and utility.

Results

GS audit: 23 CTs, 50% needed GS admission, 25% another specialty & 25% did not need admission. ED audit 147 pts with GI code, 34 potential EL, 20 had CT, but only 15 referred from ED to GS. STT CT Audit: 139 CT, no discrepancies, 7 EL patients (5%), 134 (96%) changed management, 66 (54%) admissions avoided, 11% new cancers diagnosed.

10 - 12 STT CTs per day needed (1/30,000 population/day), 66 EGS admissions (132 bed days) avoided

Conclusions

Calculation of STT CT requirement is possible for EL patients & leads to fewer admissions and “missed” EL patients. For those patients not requiring EL diagnosis is confirmed and management changed.