Case study: QI Notify EmLap – A digital solution to support Quality Improvement along the emergency laparotomy pathway

What is QI Notify EmLap and what does it do?

QI Notify EmLap, developed by The Dudley Group NHS Foundation Trust with support from the Health Innovation West Midlands (HIWM), is a digitally assisted solution to support clinicians in their emergency laparotomy quality improvement work.

Acute abdominal pain requiring assessment in hospital can be a symptom of a serious underlying illness and in some instances, if left untreated, the illness can progress to cause rapid clinical deterioration and even death. For some patients, emergency major abdominal surgery, referred to as an ‘emergency laparotomy’ (EmLap), can be lifesaving. Therefore, identifying which patients need this surgery and accessing theatre before deterioration occurs is a high priority.

An emergency laparotomy pathway supports the delivery of this and the National Emergency Laparotomy Audit (NELA) supports hospitals with data to facilitate continuous Quality Improvement (cQI) of the pathway. NELA data is collected at the point of surgery and again at discharge, but it is not easy to share this with the full multidisciplinary team who contributed to the patient’s care ‘from door to theatre’, in a way which is both meaningful and timely.

QI Notify EmLap is a digital solution which helps to address this challenge. It transforms coded data (mainly from NELA) which has been securely uploaded, into a ‘scrollable timeline’ viewable via an app on a user’s smart device. No data is stored on the user’s device and the timeline is accompanied by a narrative description of the individual patient’s hospital journey.

QI Notify EmLap can release reports at two discreet time points – shortly after surgery and again at hospital discharge. These reports provide clinicians and others responsible for the emergency laparotomy pathway with the ‘near real-time’ information necessary to perform a ‘mini case note review’. Members of the team can review an individual case record within a few minutes, at a time convenient to them, and provide open feedback and learning which is captured centrally. QI Notify EmLap thereby enables learning from every patient journey to better understand why and how elements of care work well, to ensure this is replicated

What were the aims of the QI Notify EmLap Quality Improvement project?

To make data from the National Emergency Laparotomy Audit (NELA) readily interpretable for local staff responsible for delivery of the emergency laparotomy pathway.

To provide a ‘near real time’ overview of each patient’s journey to theatre, allowing clinicians to contextualise the effectiveness of their intervention(s) while events are still recent.

To enable NHS professionals responsible for delivering the emergency laparotomy pathway to review standards and reflect on the delivery of clinical best practice and provide feedback for enhancing the care of future patients.

What did we do?

HIWM has supported the project from the outset, working with The Dudley Group NHS Foundation Trust and their development partners Exploding Phone1 (a West Midlands based app developer), to create the QI Notify EmLap digital solution. We continue to support the project and the related data governance processes to ensure the solution remains compliant with evolving regulatory requirements.

Progress and next steps

A QI Notify EmLap prototype is being piloted amongst a group of NHS professionals within The Dudley Group NHS Foundation Trust, to assess delivery against the initial aims. So far, this is limited to 11 individuals, reviewing 155 case records, and providing a total of 61 reflections.

Separate feedback on the digital solution itself is being used to plan version 2.0 for wider rollout locally. In addition to a redesign to enhance functionality and useability, this will include updates to ensure QI Notify EmLap maintains compliance with NHS data regulation, by undertaking an independent assessment (including ORCHA2 accreditation) and is generically applicable to other hospitals utilising NELA to support cQI of their emergency laparotomy pathway.

For more information about QI Notify EmLap, please contact Ellen Hughes on ellen.hughes@healthinnovationwm.org.

1.Exploding Phone: https://www.explodingphone.com Wheeley Ridge, Wheeley Road, Alvechurch, Worcestershire, B48 7DD. David Stephenson, david.stephenson@explodingphone.com, 07748704061.

2.ORCHA: https://orchahealth.com Sci-Tech Daresbury, Vanguard House, Keckwick Lane, Daresbury, WA4 4AB. hello@orcha.co.uk