Cholecystectomy Quality Improvement Collaborative (Chole-QuIC)
The 2016 report ‘Emergency general surgery: challenges and opportunities’ highlighted variation in outcomes as one of the greatest challenges faced by emergency general surgery.1
Gallstone related diseases account for approximately one third of emergency general surgery admissions and referrals and there is wide variation in the management of these patients, with cholecystectomy rates within 10 days of first admission (i.e. urgent cholecystectomy) for acute cholecystitis ranging from 0% to 35% across England.2
Chole-QuIC was initiated by the Royal College of Surgeons of England (RCS) and aimed to reduce time to urgent cholecystectomy for eligible patients with acute biliary pain or cholecystitis or gallstone pancreatitis, by using quality improvement (QI) methodology to empower clinicians to drive change within their own hospital trusts.
The goal of Chole-QuIC was for 80% of eligible, admitted patients* to receive their cholecystectomy within 8 days of presentation at hospital, in line with NICE guidance.3
*Patients with acute biliary pain / cholecystitis or gallstone pancreatitis who are assessed as medically fit for surgery and choose to have surgery on an urgent basis.
The project was launched during the first collaborative meeting on Thursday 6th October 2016. All 13 participating hospitals attended – giving a varied audience of surgeons, nurses anaesthetists and managers.
Watch the video below to discover more about Chole-QuIC.
The project used a healthcare collaborative approach; defined as a short-term learning approach that brings together a number of teams from hospitals to seek improvement in a focused topic area.4
Combined with QI methodology, the use of a QI collaborative aims to close the gap between potential and actual performance by testing and implementing changes quickly across many groups.5 Project teams from each hospital will looked at the best examples of care from academic research and other hospitals that have already achieved success in this area. Sharing of learnings within the collaborative allows each group to benefit from the successes and failures of others addressing similar issues, reducing duplication of effort and allowing solutions to be reached more rapidly.
QI involves implementing multiple, rapid cycles of change – in response to a specific, predetermined problem - and adapting the approach based on the results seen from each change. This is known as a PDSA (‘Plan, Do, Study, Act’) cycle and has the benefit of allowing solutions to be tailored to the local environment, taking into account the context of the hospital they are being implemented in. Data was collected throughout to help hospital teams understand areas for potential improvement and measure the effect that changes are having. Key data points were ‘time from presentation to diagnosis’ and ‘time to surgery’.
Support from clinical and QI experts was provided by the RCS though on-site coaching sessions, telecons, webinars, email support, and facilitation of group collaborative meetings.
The project completed in January 2018.
Our evaluation papers (listed below) demonstrate that participating hospitals substantially improved outcomes for patients by significantly reducing time to surgery for patients needing an emergency cholecystectomy. Here is a link for the related press release.
- Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project - Implementation Science.
- Effectiveness of a quality improvement collaborative
in reducing time to surgery for patients requiring emergency cholecystectomy - BJSOpen.
You can learn more about the lessons from the project in the RCS Bulletin.
- Site Lead blog: read more about the project from a site lead's point of view in Nabeel Qureshi's blog.
- Clinical lead blog: read about the project from the perspective of Ian Beckingham, Clinical Lead for the project.
Find out more
Related pagesOur vision for improving emergency surgery is supported by the recent Nuffield Trust report Emergency General Surgery: Challenges and Opportunities.
- RCS Council lead: Mr John Abercrombie, Consultant Colorectal Surgeon, Nottingham University Hospitals NHS Trust.
- Clinical lead: Mr Ian Beckingham, Consultant Laparoscopic and Hepatobiliary and Pancreatic Surgeon, Nottingham University Hospitals NHS Trust.
- QI support: Jonathan Bamber, Independent Quality Improvement Specialist.
- QI support: Tim Stephens, Quality Improvement Specialist and Nurse Researcher, Critical Care and Perioperative Medicine Research Group, Queen Mary, University of London.
- Clinical advisor: Nial Quiney, Emergency Laparotomy Collaborative (ELC) Clinical Lead and Consultant in Anaesthetics and Intensive Care (ICM), Royal Surrey County Hospital NHS Trust.
For additional information, please contact:
- Sheena MacSween, Project Manager
Phone: 020 7869 6264
Please note we are unable to accept any further applications to join the project.
- Abertawe Bro Morgannwg University Health Board (Princess of Wales Hospital);
- Basildon and Thurrock University Hospitals NHS Foundation Trust (Basildon University Hospital);
- Bradford Teaching Hospitals NHS Foundation Trust (Bradford Royal Infirmary);
- East Sussex Healthcare NHS Trust (Conquest Hospital);
- Frimley Health NHS Foundation Trust (Wexham Park Hospital);
- Lancashire Teaching Hospitals NHS Foundation Trust (Royal Preston Hospital);
- Medway NHS Foundation Trust (Medway Maritime Hospital);
- North Bristol NHS Trust (Southmead Hospital);
- Northern Devon Healthcare NHS Trust (North Devon District Hospital);
- Plymouth Hospitals NHS Trust (Derriford Hospital);
- Sherwood Forest Hospitals NHS Foundation Trust (Kings Mill Hospital);
- University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital);
- University Hospitals Coventry and Warwickshire NHS Trust (University Hospital Coventry).
1. Emergency general surgery: challenges and opportunities, The Nuffield Trust. 2016. Available at: http://www.nuffieldtrust.org.uk/publications/emergency-general-surgery-challenges-and-opportunities.
2. SWORD database: http://www.augis.org/sword/.
3. National Institute for Health and Care Excellence, 2015, Gallstone disease: Quality standard (QS104): https://www.nice.org.uk/guidance/qs104.
4. See the Institute of Healthcare Improvement’s Breakthrough Series Collaborative work for more information.
5. Improvement collaboratives in healthcare, Health Foundation, 2013: http://www.health.org.uk/publication/improvement-collaboratives-health-care.