# Improving Adherence to National Laparoscopic Appendicectomy Documentation Guidelines: A Quality Improvement Project

## TL;DR

This study improved surgical documentation quality by implementing a checklist and electronic templates aligned with national guidelines.

## Contribution

The novel contribution is demonstrating that an electronic template significantly improves adherence to laparoscopic appendicectomy documentation standards.

## Key findings

- Electronic template implementation achieved 100% documentation in several categories by cycle three.
- Documentation completeness improved progressively across three audit cycles.
- Skin preparation documentation declined due to template omission.

## Abstract

Background

High-quality operative documentation is critical for clinical communication, patient safety, audit, education, and medico-legal protection. In 2022, the Get It Right First Time (GIRFT) initiative published best practice guidelines for laparoscopic appendicectomy documentation, detailing 44 recommended data points. This study aimed to improve adherence to these standards within a district general hospital through a three-cycle quality improvement project.

Materials and methods

A Plan-Do-Study-Act methodology was employed across three audit cycles (April 2024, September 2024, and January 2025). All laparoscopic appendicectomy cases meeting the inclusion criteria were assessed using a GIRFT-based audit tool. Interventions included a governance meeting, an in-theatre checklist (post-cycle one), and the introduction of an electronic operative note template aligned with GIRFT guidance (post-cycle two). Data were analyzed descriptively, and percentage improvements between cycles were calculated.

Results

Fifty-six operation records were analyzed (20 in cycle one, 18 in cycles two and three). Progressive improvements in documentation completeness were observed across most categories, with the most significant gains following electronic template implementation. By cycle three, multiple sub-categories, including appendix details, entry to abdomen, and operative prep, achieved 100% documentation rates (18/18). The only significant decline was in skin preparation documentation (-100%), due to a template omission.

Conclusions

Structured interventions, particularly an electronic operative note template aligned with GIRFT standards, substantially improved operative documentation quality. These low-cost, scalable changes could be replicated in other centers. Future work should assess long-term sustainability and explore parallel implementation of electronic consent templates.