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Cholecystectomy Quality Improvement Collaborative (Chole-QuIC)

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 for acute cholecystitis ranging from 0% to 35% across England. For this reason, RCS England developed the Chole-QuIC collaborative, a nationwide project that focuses on improving the quality of care for patients with acute gallstone disease.

The projects aim to improve outcomes for patients with gallstone disease by reducing variation and reducing time to surgery by using quality improvement (QI) methodology to empower clinicians to drive change within their own hospital trusts. 

Chole-QuIC was launched in 2016 and was followed by CholeQuIC-ER and Chole-QuIC3. You can find out more about each of these collaboratives below, or visit our HandsFirst QI Collaborative page to find out about our newest quality improvement project.

What are the benefits to joining a QI Collaborative?

  • Support from clinical and QI experts through coaching sessions, email support and teleconferences.
  • Access to a local data platform.
  • Peer collaboration with colleagues at participating sites.
  • Attendance at webinars and collaborative events.
  • Specially designed programme to meet your trust or health board’s specific needs.
  • The opportunity to improve emergency gallstone pathways, relieve pressure on the system and save your service money.

Methodology

The projects use 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 collaboratives 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 look 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 is collected throughout to help hospital teams understand areas for potential improvement and measure the effect that changes are having. 
Chole-QuIC

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. The project launched in October 2016 and closed in January 2019, with 13 participating hospitals. Watch the video below to discover more about Chole-QuIC.

 

 

 *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.

Evaluation publications

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. Read 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. 

CholeQuIC-ER

CholeQuIC-ER launched in July 2019 and reached it’s conclusion in December 2020. The project worked with 22 trusts and health boards across the UK to radically improve outcomes for their patients with gallstone disease by implementing and expanding the learning from Chole-QuIC.

Chole-QuIC3

We launched our third Cholecystectomy Quality Improvement Collaborative 3 (Chole-QuIC3) in April 2021. This project offers the opportunity for trusts/health boards across the UK to dramatically improve outcomes for patients with gallstone disease. 

It is clear that COVID-19 will be with us for the foreseeable future and that it has put extreme pressure on surgical services. Chole-QuIC 3 will focus on how sites can improve pathways for emergency gallstone patients, this will not only improve patient care but also relieve pressure on the system. Our current CholeQuIC-ER cohort (2019-20) have continued to make excellent progress since laparoscopic surgery restarted in May 2020, with better average times to surgery and reduced variation compared to before the COVID-19 pandemic. They have demonstrated that Quality Improvement tools are effective ways to drive change in this environment that is dynamic and can change rapidly at short notice. We will be utilising lessons learned during CholeQuIC-ER to help Chole-QuIC3 sites improve their emergency gallstone service.

The project will use proven Quality Improvement methods and offer ongoing support to clinicians and managers to drive improvements in their hospitals. Each site will be given tailored support to make improvements depending on their local context and unique set of challenges. For sites that already have excellent eight-day surgery rates the focus will be on 'sustaining excellence'.

Timeline 

CholeQuIC3 timeline

Participating sites

Chole-QuIC

Basildon and Thurrock University Hospitals NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
Cwm Taf Morgannwg University Health Board
East Sussex Healthcare NHS Trust
Frimley Health NHS Foundation Trust
Lancashire Teaching Hospitals NHS Foundation Trust
North Bristol NHS Trust (Southmead Hospital)
Northern Devon Healthcare NHS Trust
Plymouth Hospitals NHS Trust
Sherwood Forest Hospitals NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospitals Coventry and Warwickshire NHS Trust 

CholeQuIC-ER

Aneurin Bevan University Health Board
Belfast Health and Social Care Trust
Brighton and Sussex University Hospitals NHS Trust
Cardiff & Vale University Health Board
Croydon Health Services NHS Trust
Cwm Taf Morgannwg University Health Board
Dartford and Gravesham NHS Trust
East Lancashire Hospitals NHS Trust
Great Western Hospitals NHS Foundation Trust
Imperial College Healthcare NHS Trust
Kingston Hospital NHS Foundation Trust 
Manchester University NHS Foundation Trust
North Cumbria University Hospitals NHS Trust
North Middlesex University Hospital NHS Trust
Royal Devon and Exeter NHS Foundation Trust
Royal Free London NHS Foundation Trust
Royal Surrey County Hospital NHS Foundation Trust
The Dudley Group NHS Foundation Trust
The Royal Bournemouth and Christchurch NHS Foundation trust
United Lincolnshire Hospitals NHS Trust
University Hospitals of North Midlands NHS Trust
Wrightington, Wigan And Leigh NHS Foundation Trust 

Chole-QuIC3


Bedfordshire Hospitals NHS Foundation Trust Luton & Dunstable
Brighton and Sussex University Hospitals NHS Trust 
Cwm Taf Morgannwg University Health Board
East Lancashire Hospitals NHS Trust 
James Paget University Hospital NHS Trust
Liverpool University Hospitals NHS Foundation Trust
Mid And South Essex NHS Foundation Trust
North Cumbria University Hospitals NHS Trust
Royal Free London NHS Foundation Trust
The Royal Bournemouth and Christchurch NHS Foundation trust
The Whittington Health NHS Trust
University Hospitals Bristol And Weston NHS Foundation Trust 
 

References

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

More information

For additional information, please contact:

Sheena MacSween, Project Manager
Email: cholequic@rcseng.ac.uk
Phone: 020 7869 6264



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