‘Critical’ role of GPs in new laparotomy clinical standard

A new clinical standard emphasises the ‘critical’ role of GPs in improving outcomes for patients who undergo laparotomy surgery for life-threatening abdominal conditions.
 
The Emergency Laparotomy Clinical Care Standard was launched by the Australian Commission on Safety and Quality in Health Care (ACSQHC) this month.
 
The document contains guidance on emergency laparotomy carried out to address urgent conditions such as a bowel obstruction, perforation or serious internal bleeding, with its guidance on the process for post-hospital care stressing the role of general practice.  
 
The surgical procedure is known as a high-risk process with a long recovery and varied outcomes, which were among the reasons the ACSQHC worked to produce the standard according to the commission’s medical adviser and GP Dr Phoebe Holdenson Kimura.
 
She said the overall in-hospital mortality for the surgery sits at around 7%, but for older adults and patients with serious comorbidities those rates can reach 20% or higher.
 
‘Even when we think outside of mortality rates, postoperative complications, extended hospital stays and unplanned readmissions are very common,’ she told newsGP.
 
‘For those who do survive and discharge from hospital, many of them experience poor outcomes, including functional decline and loss of independence.’
 
Dr Holdenson Kimura said the ACSQHC prioritised the development of a clinical standard given strong evidence of ‘unwarranted variation’ across Australia as well as a growing evidence-base about the effectiveness of quality improvement.
 
With significant support often required after surgery, she points GPs towards the standard’s ‘quality statement nine’, which covers the transition from hospital and emphasises the detail required for ongoing care.
 
‘For example, it’s got the contact details of the treating team and information about what to do if that patient has complications or deteriorates,’ she said
 
‘The clinical care standard is really clear about what that transition from hospital is meant to look like and the responsibility on the hospital and that’s really great news for GPs.’
 
The standard states that GPs ‘play a critical role in monitoring complications, supporting medication changes, managing multimorbidity and psychosocial recovery’.
 
It also emphasises the importance of involving a geriatrician or other clinicians skilled in perioperative care of older people, with more than half of patients aged over 65, many of whom are frail.
 
She said the other message for GPs is to ensure a comprehensive assessment when patients present with abdominal pain to expedite intervention if required.
 
According to the ACSQHC, only 59% of patients have surgery within recommended timeframes.
 
The clinical standard may have even broader relevance for rural GPs and Rural Generalists.
 
‘For those clinicians who are working within the hospital system itself, I’d urge them to have a closer look at the clinical care standard to understand what those implications are for their practice,’ Dr Holdenson Kimura said.
 
She hopes the impact of the clinical standard will echo improvements seen following the introduction of clinical standards using an orthogeriatric model of care for hip fracture and stroke patients.
 
She also points to the UK’s National Emergency Laparotomy Audit, which was followed by a significant fall in mortality and reduced length of hospital stay.
 
‘If we map the whole journey out and provide that in a consistent way, then we know that people are going to have better journeys and better outcomes,’ Dr Holdenson Kimura said.
 
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ACSQHC bowel laparotomy surgery