Title : Are we assessing and documenting mortality risk scores for patients undergoing emergency laparotomy? A clinical audit
Abstract:
Background: Emergency laparotomy is associated with significant morbidity and mortality (1). Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. The 30-day postoperative mortality rate is 8.1% (2). Assessing mortality risk before surgery is important for informed consent, peri-operative planning and identifying patients who may need a higher level of care (3). This audit aimed to assess how consistently mortality risk scores were being calculated, documented and discussed with patients undergoing emergency laparotomy.
Method: We carried out a retrospective audit over a six-month period. Patients who underwent emergency laparotomy were identified using the electronic theatre management system. Medical records and consent forms of 45 patients were reviewed to see whether a mortality risk scores had been calculated, discussed with the patient and documented in both the clinical notes and consent form. Compliance was assessed against National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommendations, with a target of 100% (3). Patients undergoing laparoscopic procedures or laparotomy for gynaecological indications were excluded.
Results: Thirty-four patients were included. Mortality risk scores had been calculated and documented in only 6/34 patients (17.6%). Only 2/34 patients (5.9%) were fully compliant, with both NELA and P-POSSUM scores calculated, documented in the medical record and consent form, and discussed with the patient. A further 4/34 patients (11.8%) showed partial compliance, either because only one score had been calculated or because documentation was incomplete.
Recommendations: Overall compliance with recommended pre-operative mortality risk assessment and documentation was low. Suggested changes included increasing staff awareness through education and displaying posters, discussing compliance regularly at clinical governance meetings, and adding dedicated mortality risk sections to clerking and emergency theatre booking documentation. A re-audit following these changes would assess whether compliance has improved and complete the audit cycle.
