Rotherham Hospitals NHS Foundation Trust Aim:

The aim of our study is to review the decision making process for patients admitted to our unit suffering from a pathology correctable only via an emergency laparotomy.

Methods:

We selected a sample of 75 patients admitted to our unit with surgical pathology correctable only via an emergency laparotomy: 25 had surgery and survived, 25 had surgery and died within thirty days, 25 were deemed not fit for a laparotomy. We created 75 case vignettes representative of the cases at admission. We then removed any information concerning real life outcomes and submitted the vignettes for assessment to consultant surgeons, anaesthetists and intensivists asking them if they would or not offer an emergency laparotomy. Concordance between assessors and real life decision were calculated. The data was analysed using Judgement Analysis methodology (binomial logistic regression specifically) to identify factors playing a role in the decision making process.

Results:

Median age of included patients was 73 years (29-96), 40 (53%) were male. Median preoperative NELA score was 12.9% (0.2%-64.9%). Eight consultants (3 surgeons, 3 anaesthetists, 2 intensivists) participated to the exercise for a total of 600 responses. Average concordance between real life decision and decision taken based on case vignettes was 78.64% (72%-84%) with variations between the eight consultants. Judgement analysis revealed significant variations in variables affecting decision making by different clinicians.

Conclusions:

Different clinicians, when provided with the same level of information, take different decisions. Our data supports the importance of multidisciplinary involvement in decision making for emergency laparotomy care.