Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy

Why it matters

Gallbladder removal – known as cholecystectomy – is one of the most common emergency surgeries, and the eventual treatment for many people presenting with gallstone-related symptoms.

For people who need a cholecystectomy, evidence shows that the sooner they have one, the better. Shorter wait times can minimise their readmissions and reduce their overall length of stay in hospital. But wait times for cholecystectomy vary across the UK, often failing to meet national guidelines that recommend surgery within fewer than eight days of presentation.

The Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) was established to help UK hospitals reduce wait times in line with those standards.  A total of 13 hospitals from England and Wales were recruited, and provided with expert quality improvement support to help them develop and implement improvement solutions.

This study aimed to evaluate the impact of that collaborative, and determine whether participating hospitals were able to reduce cholecystectomy wait times.

Our approach

To evaluate the collaborative, we collected data about patients in England and Wales who were admitted with relevant symptoms and subsequently had a cholecystectomy between 1 April 2014 and 3 December 2017.

We analysed the data by comparing time-to-surgery rates between a baseline period and an intervention period for each collaborative hospital, for the sites that actively participated in the collaborative, and for a control group of more than 130 English and Welsh hospitals.

What we found

• Twelve of the thirteen hospitals participated fully throughout the collaborative programme, while one withdrew voluntarily.
• Overall, the collaborative cohort significantly increased its rate of cholecystectomy surgeries done within the 8-day standard (compared to the control group of hospitals not involved in the collaborative).
• On an individual level, eight of 12 participating hospitals increased early cholecystectomy rates significantly – even when accounting for a small overall improvement in national rates.
• For successful hospitals, improvement seemed to be influenced by:
  • Changing local culture to recognise the benefits of quick surgical interventions
  • Creating capacity in surgical theatres and moving patients through the surgery pathway
  • Having dedicated time to run improvement projects and turn ideas into action
  • Having clarity of purpose and stakeholder support
• Quality improvement collaboratives are most successful when they focus on issues where there is consensus about what change is required, and solutions that are supported by respected professional bodies.
• A linked paper, reports the findings of a process evaluation, and provides further detail on some of the influences on success.

Related content from our open-access series, Elements of Improving Quality and Safety in Healthcare