In a landmark shift for emergency medicine within the National Health Service (NHS), Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (WWL) has successfully digitised its Acute Abdomen Pathway. By embedding National Emergency Laparotomy Audit (NELA) clinical guidance directly into the Altera Digital Health "Sunrise" electronic patient record (EPR) system, the trust has effectively bridged the gap between national clinical standards and frontline bedside practice.
This initiative, which recently received the "Best Audit and Quality Improvement" award at the trust’s Clinical Audit Best Practice event, serves as a blueprint for how NHS trusts can leverage EPR flexibility to reduce clinical variation, improve patient safety, and significantly accelerate diagnostic timelines in high-acuity scenarios.
The Core Objective: Moving Beyond Paper-Based Vulnerabilities
Historically, the management of acute abdominal pain—a complex clinical presentation that can range from benign conditions to life-threatening emergencies—was hampered by the limitations of paper-based documentation at WWL. Relying on physical charts often led to fragmented communication, inconsistent application of clinical protocols, and, ultimately, delays in care.
For a condition where minutes often dictate the difference between a successful recovery and a poor prognosis, the lack of a unified, digital-first approach created a "variation in care" problem. Clinicians struggled to ensure that every patient, regardless of the time of day or the shift rotation, received the same gold-standard assessment and rapid escalation to surgical or specialist teams.
The integration of NELA guidance into the Sunrise EPR was designed specifically to dismantle these barriers. By providing decision support at the point of care, the system now prompts clinicians to follow evidence-based protocols tailored to the patient’s specific clinical presentation, effectively automating the adherence to national safety standards.
A Chronology of Clinical Innovation
The transition at WWL was not an overnight overhaul but a calculated, phased integration of clinical informatics and operational strategy.
- Pre-Digital Era: The pathway relied on disparate paper documentation, leading to inconsistencies in triage, risk assessment, and referral timings.
- The Implementation Phase: Clinical leaders, including Dr. Andrew Starkie and Petro Bekker, spearheaded the configuration of the Altera Sunrise platform. The focus was on "clinical usability"—ensuring that the digital tools didn’t just exist, but actually helped the clinician.
- The Go-Live: The trust deployed the NELA-integrated pathway, which featured one-click CT ordering, automated mortality risk scoring, and mandatory prompts for specialist referrals.
- The Validation Phase: Post-implementation audits revealed a dramatic spike in performance metrics, most notably in diagnostic speed.
- Current State: The trust is now exploring the expansion of the "NELA Nurse" role, aiming to further support post-operative recovery and collect granular patient feedback to drive continuous improvement.
Supporting Data: Quantifying the Impact
The results of the digitisation project are nothing short of transformative. By removing manual friction from the process, WWL has reported significant improvements across multiple key performance indicators (KPIs):
- Documentation Compliance: The trust has achieved a remarkable 100% compliance rate with Acute Abdomen Pathway documentation standards. This ensures that every clinical interaction is audited and aligned with national best practices.
- Diagnostic Velocity: Perhaps the most critical metric for patient outcomes is the speed of imaging. The percentage of urgent CT scans reported within the vital one-hour window has surged from 41% to 76%. This 35-percentage-point increase represents a massive reduction in the time patients spend in diagnostic uncertainty.
- Comprehensive Specialist Review: The system now enforces full completion of age-related and complex medicine reviews, alongside mandatory critical care outreach team (CCOT) consultations for high-risk patients. This "fail-safe" mechanism ensures that no high-risk patient slips through the cracks of a busy emergency department.
Official Perspectives: Bridging Informatics and Bedside Care
The success of the WWL project highlights the importance of collaboration between IT providers and clinicians.
Petro Bekker, Chief Nurse Information Officer and Associate Director of Clinical Informatics at WWL, noted:
"The digital transformation of our Acute Abdomen Pathway within the Sunrise EPR platform has demonstrated improved compliance with best practice documentation and guidance. By streamlining critical processes and making them intuitive for clinicians, we’ve seen tangible improvements in patient care, from faster CT reporting to comprehensive geriatric reviews."
Dr. Andrew Starkie, Accident and Emergency Consultant at WWL, added:
"Embedding the pathway into our ED electronic patient record has substantially improved how we assess patients with an acute abdomen, enabling better risk stratification and more effective organisation of ongoing care."
Mark Hutchinson, Executive Vice President at Altera Digital Health (UK & EMEA), provided the vendor perspective:
"Their success in leveraging the flexibility of the Sunrise EPR platform to embed NELA guidance is a powerful example of how a configurable digital health solution adds value. This approach streamlines workflows, maximises productivity and crucially enhances patient safety and outcomes, empowering trusts to drive impactful, tailored change."
Implications for the Wider NHS
The WWL project arrives at a pivotal moment for the NHS. As the health service moves toward more integrated care systems (ICS), the ability for trusts to share data and standardize care pathways is becoming a top priority.
1. Scaling Success Across the North West
The expansion of Altera Digital Health’s footprint in the region—notably the recent contracts awarded by Stockport NHS Foundation Trust and Tameside and Glossop Integrated Care NHS Foundation Trust—suggests that the "WWL model" could become the standard for the Greater Manchester area. These 10-year contracts are specifically aimed at improving patient flow and standardizing digital infrastructure, creating a regional ecosystem where clinical best practices can be replicated with ease.
2. The Power of "Configurable" EPRs
The industry has moved away from rigid, "one-size-fits-all" software toward highly configurable EPRs. The ability to embed national audit standards (like NELA) into the workflow means that the software acts as a "clinical co-pilot." For junior doctors or locum staff who may be unfamiliar with trust-specific policies, these digital prompts provide an essential safety net, ensuring high-quality care is provided consistently.
3. Future-Proofing Patient Care
The focus on the "NELA Nurse" role indicates that WWL is looking beyond the initial acute crisis. By using the EPR to track long-term recovery and patient-reported outcomes, the trust is evolving its model from a purely transactional emergency service into a holistic, patient-centered pathway.
Conclusion: A New Standard for Emergency Medicine
The partnership between WWL and Altera Digital Health demonstrates that digital transformation is not merely about replacing paper with screens; it is about re-engineering clinical workflows to serve the patient more effectively.
By prioritizing the integration of national audit standards into the daily workflow of the ED, WWL has proven that clinical informatics can be a primary driver of patient safety. As the NHS continues to grapple with increasing demand and workforce challenges, the ability to "automate quality" through EPR configuration will likely become the single most important factor in sustaining high-performance emergency care across the country.
The success at Wigan serves as a compelling call to action for other trusts: the tools to reduce clinical variation are already present within modern EPR systems—the challenge lies in the clinical leadership required to implement them as effectively as WWL has done.
