A medical trial looking at ways to improve the quality and delivery of care for patients having emergency abdominal surgery

Conditions

Emergency Laparotomy Surgery

Carol J. Peden, Tim Stephens, Graham Martin, Brennan C Kahan, Ann Thomson et al. (27 authors)

Health Services and Delivery Research2019-09-0113 citations

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial.

Peden CJ, Stephens T, Martin G, Kahan BC, Thomson A, Rivett K, Wells D, Richardson G, Kerry S, Bion J, Pearse RM, Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial group.

2019-04-25116 citations

10.1016/s0140-6736(18)32521-2

Improving care at scale: process evaluation of a multi-component quality improvement intervention to reduce mortality after emergency abdominal surgery (EPOCH trial).

Stephens TJ, Peden CJ, Pearse RM, Shaw SE, Abbott TEF, Jones EL, Kocman D, Martin G, EPOCH trial group.

2018-11-1367 citations

10.1186/s13012-018-0823-9

Interventions

The EPOCH trial intervention is comprised of a Quality Improvement project to promote implementation of an Integrated Care Pathway for patients undergoing emergency laparotomy Ninety

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: Patients - All patients aged 40 years and over undergoing non-elective open abdominal surgery in participating hospitals during an 85 week period will be eligible for inclusion in the data analysis. The patient inclusion criteria are identical to those of the Healthcare Quality Improvement Partnership National Emergency Laparotomy Audit (HQIP-NELA) and the core EPOCH dataset will only include patient level data gathered by the audit. Hospital sites and clusters - Participating hospitals must undertake a significant volume of emergency laparotomies, participate in the National Emergency Laparotomy Audit, nominate specialty leads from surgery, anaesthesia and critical care, and secure the support from their NHS Trust Board to participate in the EPOCH study. Hospitals which already use an integrated care pathway to maintain standards of care for this patient group will be excluded. Clusters will be organised geographically with specific attention to the rotation of clinical staff and patient referral patterns between hospitals to minimise contamination of pre-intervention hospitals.

Exclusion criteria

Exclusion criteria: The following patients will be excluded: 1. Simple appendicectomy 2. Gynaecological laparotomy 3. Surgery related to organ transplant 4. Laparotomy for traumatic injury 5. Laparotomy to treat complications of recent elective surgery 6. Patients whose data has previously been included in the EPOCH trial

Design outcomes

Primary

Measure	Time frame
All cause mortality at 90 days following surgery	—

Secondary

Measure	Time frame
1. All cause mortality at 180 days following surgery 2. Duration of hospital stay 3. Hospital re-admission within 180 days of surgery In six hospitals we will collect EQ-5D 3L and healthcare resource use data preoperatively, and at 90 and 180 days post surgery to perform a health economics analysis.	—

Countries

England, United Kingdom

Outcome results

None listed