A new national standard for emergency laparotomy aims to tighten hospital care while strengthening the handover to general practice.
A new clinical care standard for emergency laparotomy is set to reshape how some of Australia’s sickest surgical patients move through the health system.
And general practitioners have been positioned as central to continuity of care rather than bearing the brunt of responsibility.
Developed by the Australian Commission on Safety and Quality in Health Care, the standard targets a high-risk procedure performed on about 15,000 Australians each year, often in life-threatening circumstances and with significant risk of complications, mortality and long-term decline.
The first Emergency Laparotomy Clinical Care Standard was launched at the Royal Australasian College of Surgeons Annual Scientific Congress in Perth last week.
While the framework focuses heavily on hospital-based care, it draws a clearer line between acute treatment and community recovery, an area where gaps in communication have historically undermined outcomes.
The standard focuses on emergency laparotomy for urgent conditions affecting the gastrointestinal tract, like a bowel obstruction, perforation or serious internal bleeding.
The commission’s medical advisor and GP, Dr Phoebe Holdenson Kimura, said the intent was not to shift pressure onto GPs, but to better equip them for a role they already play.
“GPs are a really important player in providing high-quality care across that whole journey,” she told The Medical Republic, noting that their involvement spanned early assessment, escalation where needed and ongoing recovery in the community.
Patients who ultimately required emergency laparotomy often first presented in general practice with non-specific symptoms such as abdominal pain, a common complaint that rarely signals the severity to come.
“Only a small proportion will go on to need emergency surgery,” Dr Holdenson Kimura said.
“But it’s about being really attuned to the possibility that the person in front of me may actually be really sick and may require surgery within hours.”
The standard reinforced existing GP practices around careful assessment and timely escalation, including clearer communication with emergency departments when serious pathology was suspected.
It also acknowledged the unique role of GPs in advocating for vulnerable patients, particularly older people or those with cognitive impairment who may present atypically and risk delayed diagnosis.
The most tangible change for general practice, however, was expected after discharge. A core requirement of the standard was that patients left hospital with a detailed, individualised care plan, provided to both the patient and their GP at the time of discharge.
“The GP needs to receive really detailed, high-quality information about what happened during the hospitalisation, but also what sort of care the patient needs on discharge,” Dr Holdenson Kimura said.
These plans were designed to support early follow-up and coordinated care, outlining medications, wound management, nutrition, rehabilitation and potential complications, alongside direct contact details for the treating surgical team.
“For me as a GP, if I received that care plan on a Monday morning, it would set in motion a whole range of interventions – but it always starts with early review,” she said.
The approach aimed to reduce preventable readmissions, which were often linked to fragmented communication or uncertainty about post-operative management.
It also recognised that recovery from emergency laparotomy can be prolonged and complex, particularly for older or frail patients whose functional status may decline significantly.
“That first appointment is often just helping the patient make sense of what’s happened,” Dr Holdenson Kimura said.
“But I can’t do that if I don’t have the information.”
For rural and remote clinicians, the standard has broader implications. GP proceduralists and rural generalists may be directly involved in acute care, including anaesthesia, surgery and retrieval, as well as ongoing recovery closer to home.
The framework also aligns with general practice’s existing role in advance care planning, encouraging earlier conversations about goals of care that can inform high-stakes decisions in the acute setting.
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With national rollout underway, Dr Holdenson Kimura said she hoped the clearer standard would lead to better-defined communication that would help bridge longstanding divides between hospital and community care.
“We need to think about the whole healthcare system as one system,” Dr Holdenson Kimura said.
“Care doesn’t end when the patient leaves hospital, and GPs need to be supported with the information to make that care effective.”
The statistics support the need for this standard. According to the commission, each year more than 15,000 people have an emergency laparotomy, at a cost of $400 million.
More than one in five patients have sepsis on presentation, and the mortality rate sits at almost 7%. On average, two in three high-risk patients go to the intensive care unit after surgery.
However, only 59% of patients have surgery within the recommended time frame, and their average length of hospital stay is almost 13 days, the commission reported.
Unlike other life-threatening medical emergencies such as stroke or cardiac events, evidence-based clinical pathways for urgent abdominal conditions were not consistently embedded in practice, it said.
This was despite emergency laparotomy being one of the highest-risk surgical procedures, with recovery taking weeks or months and patient outcomes varying significantly.
Survival, recovery and the long-term impact on quality of life could be significantly improved with better pathways of care for critically unwell patients.
“Timeliness is crucial, and so is understanding the patient’s level of risk. The use of risk scores can create a common language and support decision-making to help ensure patients receive appropriate care,” said Dr Holdenson Kimura.
“Older people have the highest risk. More than half of emergency laparotomy patients are over 65 years old, and many are frail. For these patients, involving a geriatrician to help manage co-morbidity is shown to reduce mortality and length of their hospital stay.”
Professor David Watters, a surgeon with Deakin University and Safer Care Victoria, said an hour or two could make a big difference to the chances, or degree of recovery after emergency laparotomy.
“I’ve seen first-hand how patients can suffer because of late presentation, delayed diagnosis or referral, late recognition of complications, or failure to manage their other medical conditions,” he said.
“The Clinical Care Standard is important because it offers a comprehensive approach to providing the best care across the whole patient journey.
“All health services, even those already delivering many of these aspects of care, will find the standard offers an opportunity to reduce variation by ensuring consistency in how to provide the best care to the right patients at the right time and in the right place.”
Dr Holdenson Kimura told TMR that for some high-risk emergency laparotomy patients, the risks of surgery outweighed the benefits.
The care team must quickly assess the situation and involve the patient and their family in treatment decisions, especially when surgery may not be beneficial.
“It’s very strong around goals of care and shared decision making, and particularly for older patients or patients with really significant comorbidities, sometimes we need to have difficult conversations with patients about the possibility of a non-beneficial surgery, meaning that there’s a significant chance that they’re going to have a really negative outcome from the surgery,” she said.
“They are difficult conversations to have, but they’re important, and it’s important that the conversation is had with the most appropriate clinician.”
Dr Holdenson Kimura said she was looking forward to better outcomes for patients with the new standard.
“There is robust evidence in Australia and internationally that when we provide the care described in the new standard, it is a better outcome for everyone – with lower mortality rates, shorter hospital stays and a higher likelihood of patients returning home to their normal life and activity,” she said.
The standard was developed in collaboration with key stakeholders including the Clinical Quality Registry, the Australian and New Zealand Emergency Laparotomy Audit – Quality Improvement (ANZELA-QI), which is updating its data collection and key indicators in line with the Standard.
See the new standard here.
