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 West Midlands Academic Health Science Network (WMAHSN), 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, 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. A local emergency laparotomy pathway supports clinicians to delivery this and the National Emergency Laparotomy Audit (NELA) supports hospitals by processing their locally collected data to produce overview reports and a dashboard of charts. However important and useful these summative data sources are, continuous Quality Improvement (cQI) is most successful when supplemented by real-time, patient level data. Indeed continuous learning demands a continuous awareness of care delivery processes, and continuous feedback loops to prompt action learning. Delivering this is a challenge in many areas of healthcare, especially along as complex a pathway as this. How do we learn, share and reinforce the many examples of excellent care delivered everyday in a way that is meaningful and timely? How do we understand why delay occurred and how it could be avoided? And how do we do this across the full emergency laparotomy pathway, from ‘door’ through ‘theatre’, to ‘recovery’ and ‘discharge’? QI Notify-EmLap is a digital solution which helps address this challenge. It transforms uploaded coded data (mainly from NELA), into a ‘scrollable timeline’ and narrative description of care, that can be securely shared and viewed on the smart device of approved clinicians with an active account. It compares the care delivered to reported standards, and allows clinicians to review the standards in real time, as well as provide feedback, reflections and service improvement ideas. No data is stored on the user’s device. 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 in near real time for local staff responsible for delivery of the emergency laparotomy pathway. To provide an 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?
QI Notify-EmLap is a Dudley Group NHSFT product. We have been supported by the WMAHSN from the outset, and have also worked with ‘Exploding Phone’ 1 (a West Midlands based app developer), to create the QI Notify EmLap digital solution. We continue to develop the project with support from the WMAHSN including review and update of the APP and the associated data governance processes, ensuring it remains compliant with the evolving regulatory environment.
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 ORCHA (2) accreditation) and is generically applicable to other hospitals utilising NELA to support cQI of their emergency laparotomy pathway. We have had discussions with the Cloud Centre of Excellence team at NHS Digital including the possibility of sharing the solution across the wider NHS following further development. Here you can find further information relating to the following:
- The Dudley Group NHS Foundation Trust Privacy Notice explaining how the Trust manages personal data: Privacy Notice
- If you are interested in finding out more about Qi Notify-Emlap in your organisation or Trust please follow this Link to our expression of interest.