Emergency Laparotomy Risk Assessment: A Qualitative Study of General Surgeons and Trainees

OBJECTIVE: General surgeons perform emergency laparotomies on a heterogeneous patient population. Scoring tools have been developed to quantify the risk of mortality after EL, but the uptake of these tools is poor. We aimed to characterise the attitudes of surgeons to risk assessment tools. SETTING: Australia. PARTICIPANTS: General surgeons, registrars and residents. DESIGN: Semi-structured interviews with participants, analysed using Framework Method. RESULTS: Fifteen participants were interviewed. Barriers identified included perceived lack of utility, competing priorities, unit or hospital culture, individual surgeon attitudes, lack of funding, junior medical staff turnover, and lack of familiarity. Potential strategies for improvement identified included education, integration with electronic health records, and prompting at time of theatre booking. CONCLUSION: Our findings will be of interest to those undertaking quality improvement work with risk assessment. This is important given recommendations for universal risk assessment but the low uptake of risk assessment in practice.