What is the EPOCH study?

High-risk patients undergoing emergency surgery account for 10% of all in-patient surgical procedures but 65% of deaths. Patients who develop complications but survive, require in-hospital care for prolonged periods, suffering substantial reductions in functional independence and long-term survival. Recent data show that abdominal surgery and the need for surgery on an emergency basis are amongst the strongest factors associated with poor post-operative outcome.

Most opinion leaders agree there is an urgent need for a national project to improve survival for emergency laparotomy patients. However, there is uncertainty about how best to achieve such improvement. A report by the Royal College of Surgeons of England (RCS) described an integrated care pathway for patients undergoing emergency laparotomy which could improve the quality of care. However this is yet to be widely implemented in hospitals across the UK.

Quality improvement (QI) initiatives aim to improve patient experience and outcomes by taking a systematic approach that uses specific techniques to improve quality of care. However, doubts over the clinical effectiveness of quality improvement projects, particularly on patient outcome, continue to limit the success of these initiatives.

We propose to conduct a large pragmatic clinical trial of the effectiveness of a quality improvement project to implement a robust and evidence based integrated care pathway to improve patient outcomes following emergency laparotomy. Our aim is to provide the definitive evidence needed to inform practice in this area.

What data is the trial using?

The trial will combine data from the following sources:

  • Non Identifiable data from the National Emergency Laparotomy Audit (NELA). For more information, please visit their website: http://www.nela.org.uk
  • Non Identifiable Hospital Episode Statics data from NHS Digital
  • ONS data (Date of Death and Cause of Death) from NHS Digital

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