Client Story
Embedding National clinical guidance into the Sunrise EPR platform: Transforming the Acute Abdomen Pathway at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) identified areas for enhancement in its application of the National Emergency Laparotomy Audit (NELA) standards. This presented a significant opportunity to improve patient care and positively affect mortality and morbidity rates for individuals undergoing emergency laparotomy. The existing Acute Abdomen Pathway, primarily paper-based and underutilised, highlighted a need for improved multidisciplinary team (MDT) collaboration and timelier, evidence-based interventions.
The challenge
Patients presenting to the Emergency Department with an acute abdomen require rapid, coordinated assessment and intervention. National guidance from the National Emergency Laparotomy Audit (NELA) sets out strict, time-critical standards for imaging, senior review, antibiotics, escalation and peri-operative care. At WWL, the existing Acute Abdomen Pathway, while present, was:
- Paper-based and hosted on the intranet, making it difficult to access during time-pressured emergency care.
- Poorly understood outside specialist surgical teams, leading clinicians to rely on memory rather than structured guidance.
As a result, key NELA time targets were frequently missed, CT imaging and reporting were delayed, and communication between A&E, Surgery, Radiology and Critical Care was inconsistent.
The trust, previously identified as a NELA mortality outlier, recognised the need for a digitally enabled solution to address patient and staff needs, with a focus on aligning with NELA guidance to improve mortality and morbidity outcomes. Staff needs were also crucial, with clinicians seeking a concise, accessible and integrated pathway to streamline referrals and radiology requests, reducing wasted time and potential errors.
100% compliance
with Acute Abdomen Pathway documentation standards.
Age and Complex Medicine reviews increased from 18% to 100%
for eligible patients.
100% Completion of CCOT reviews
for high-mortality risk patients, significantly reducing returns to higher levels of care.
CT scan reporting times improved from 41% to 76%
for urgent acute abdomen scans reported within one hour.
Achieved Best Practice Tariff (BPT)
for the first time, securing ongoing funding.
A comprehensive, patient-centric approach
Rather than introducing new standalone tools, the trust partnered with its digital team to embed the acute abdomen and NELA guidance directly into existing electronic clinical documentation and ordering within the Sunrise EPR platform, designed to be intuitive and seamlessly integrated, specifically avoiding additional, form-filling for clinicians. The design principle was simple: “Put the right guidance, orders and referrals in front of clinicians at the exact moment they need them.”
“The digital transformation of our Acute Abdomen Pathway within the Sunrise EPR platform has demonstrated improved compliance with best practice documentation and guidance, prompting the clinician to follow the protocol based on the patient’s presentation,” states Petro Bekker, Chief Nurse Information Officer and Associate Director of Clinical Informatics. “By working closely with all multidisciplinary teams, we’ve not only streamlined critical processes and made them intuitive for clinicians, but we’ve seen tangible improvements in patient care, from faster CT reporting to comprehensive geriatric reviews. It’s a testament to what can be achieved when clinical insight meets innovative digital solutions.”
The solution
The project included:
- Embedded clinical decision support: When an A&E clinician selects “Acute Abdomen” or “Gastrointestinal Complaint” in the electronic assessment within the Sunrise EPR platform, the Acute Abdomen Pathway automatically appears. Red flags for sepsis and high-risk features are clearly highlighted, and the system prompts immediate patient-specific actions aligned to NELA guidance. This removed the need to search the intranet or recall complex pathways under pressure.
- One-click ordering and workflow automation: CT abdomen and associated pathway orders were embedded directly within the pathway on the Sunrise EPR platform. Clinicians could request imaging without leaving the assessment, with guidance explicitly supporting early CT when NELA criteria are met. This ensured consistency and reduced delays caused by uncertainty or navigation time.
- Risk stratification built in: The NELA mortality risk score was integrated into the clinician documentation within the Sunrise EPR platform, enabling early identification of high-risk patients, objective escalation decisions and consistent communication of risk across teams.
- Radiology integration and faster reporting: Radiology workflows were enhanced through a dedicated CT request indicator: “Potential NELA patient” from the Sunrise EPR to the radiology scheduling platform. This automatically prioritised these scans for reporting.
- End-to-end pathway coverage: Alongside A&E, the pathway is also embedded within surgical assessment documentation on the Sunrise EPR platform with automated prompts for referrals to Care of the Elderly / Complex Medicine and Critical Care Outreach. High-risk patients who do not require ICU admission receive five days of Critical Care Outreach review on the ward, delivering proactive, ICU-level surveillance.
- Trust-led design and implementation: The flexibility of the Sunrise platform enabled the trust to design and implement this functionality in house, using their internal configuration knowledge ensuring rapid turnaround and consistency with existing trust-wide EPR configuration.
Key outcomes
The digital transformation yielded significant improvements across several critical metrics:
- Acute Abdomen Pathway documentation: Achieved and maintained 100% compliance due to the design of the new pathway within the Sunrise EPR platform.
- Age and Complex Medicine reviews: Rose dramatically from an initial 18% to 100% for eligible patients (over 80, or over 65 and frail) in 2024–25.
- CCOT reviews: 100% completion of daily reviews for 5 days post-operatively for patients with a NELA mortality risk score >5%, a novel initiative that significantly reduced returns to higher levels of care.
- CT scan reporting times: Improved from 41% to 76% for amber and red flag sepsis patients with acute abdomen reported within one hour.
Best practice tariff (BPT): The trust now receives the BPT for the first time ever, securing ongoing funding for services. - Improved MDT working: Enhanced communication and collaboration across departments, leading to more responsive clinical decisions and a shared appreciation for contributions to patient care. Clinicians reported that the digital pathway provided “clear validation to escalate care and follow national guidance,” leading to improved confidence, consistency, and morale between A&E and surgical teams.
The future
The project plans to expand the role of the NELA nurse to encompass enhanced recovery and patient satisfaction/feedback. While the National Emergency Laparotomy Audit project has only recently reached completion and has not yet been presented nationally, it has already garnered internal recognition, winning “best audit and quality improvement” at the trust’s Clinical Audit Best Practice event.
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