QI Notify-EmLap

QI Notify-EmLap is a Quality Improvement (QI) tool developed by The Dudley Group NHSFT in collaboration with the West Midlands Academic Health Science Network (WMAHSN). It supports staff with responsibilities for the management of patients undergoing an emergency laparotomy to receive case by case feedback about when, how and by whom care was delivered. The tool transforms data already within the NELA (National Emergency Laparotomy Audit) record into a ‘mini case review’, highlighting where accepted standards of care appear to have been met and allowing staff to pause and reflect on their contribution in achieving these; thereby learning from their own and others best practice. Staff with an account at their hospital, receive notifications to their smart device when new case records are available, allowing them to choose a convenient moment to securely view them within the App. If unfamiliar with a particular clinical standard these can be viewed within the App. Key events along a patient’s journey are presented in a time-stamped scrollable timeline, enabling the immediate visual assessment of the timeliness of care. In these ways, the App can be used to aid training and education, allowing senior staff to review care within their team highlighting best practice and identifying opportunities to improve.

Other resources and methodologies exist to aid the assessment of how well a hospital’s emergency laparotomy pathway is functioning; however, these typically involve the presentation of retrospective, summative data, long after care was delivered. The NHS Patient Safety Strategy challenges the NHS to use digital solutions to improve timely feedback to staff [The NHS Patient Safety Strategy Safer culture, safer systems, safer patients, July 2019]. Clinical audit and feedback becomes significantly more effective when summative data is supplemented with multiple instances of feedback, delivered at individual case level, soon after an episode of care, and is also both presented in a way which closely links the visual display to the summary message, and addresses barriers to use [Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness. Brehaut et al: Annals of Internal Medicine 2016]. QI Notify-EmLap looks to achieve this for the emergency laparotomy pathway complementing existing resources and supporting staff in their efforts to deliver a continuous cycle of improvement.

Like other clinical audit and QI methodologies, QI Notify-EmLap uses data already within a clinical record, no additional patient data is collected. The USP of QI Notify-EmLap is to use ‘digital’ to transform this data early after care delivery into a meaningful ‘mini case review’ and securely share this with NHS staff whose responsibilities include the performance of their emergency laparotomy pathway. When used in conjunction with more traditional clinical audit and QI projects QIN-EmLap can accelerate efforts to improve services along this pathway.