1. National Emergency Laparotomy Audit
The 4th report
XXXXXXXXXXX Hospital
Please edit/delete slides for your own local use as required; these slides aim to support local teams in presenting their own data to multidisciplinary teams

2. 4th NELA report; 23,949 patients
NELA Database now >100,00 patients in total
4th Report published November 2018
Largest dataset about emergency laparotomy patients in the world

3. Achievements across all areas reviewed, although many improvements still required

4. Mortality: National
Trend has fallen over the 4 years of reporting from 11.8% in year 1

5. Mortality: National
National 30 day risk adjusted mortality = 9.5%

6. Mortality: National National 30 day risk adjusted mortality = 9.5%
Local 30 day risk adjusted mortality = XX %
Data source; Year 4 Hospital Level Achievement Key Process of Care:

7. Length of Stay: National
National LoS = 15.6 days
Data source = year 4 hospital level achievement key processes of care (RAG table) column AB

8. Length of Stay: National
National LoS = 15.6 days
Local LoS = XX days
Data source = year 4 hospital level achievement key processes of care (RAG table) column AB

9. 4th NELA report – the key standards
Key standards are grouped into
Preoperative assessment – including consultant review of patients and preoperative CT scanning and risk assessment before surgery
Timely access to theatres
Consultant presence in theatres
Admission to critical care
Geriatric iperioperative involvement
This radar plot graphically shows the proportions of ALL patients in year 4 who met each of the standards & clearly shows which areas (geriatrics) requires more work nationally

10. Data Ascertainment: National
National case ascertainment – 82.7%

11. Data Ascertainment: National
Hospital case ascertainment = XX %
Data source = hospital level achievement key processes of care (RAG table) column L
It may be useful to colour the text boxes according to RAG rating
Regional case ascertainment = YY %

12. CT Reported before Surgery: National
National results = 64.4%
These national results in amber, reflect the national mean reported number of scans for all CT scans performed

13. CT Reported before Surgery: local
Local results = XX %
Results column M
Regional results = YY %

14. CT Discrepancy Rates: National

15. CT Discrepancy Rates: National
Overall discrepancy rate = 5.3%

16. CT Discrepancy Rates: Local
Overall discrepancy rate = 5.3%
Local discrepancy rate = XX%
Regional discrepancy rate = YY%

17. Preop Risk Assessment: National

18. Preop Risk Assessment: Local
National preop risk assessment = 74.6%
Local preoperative risk assessment = XX%
Regional preoperative risk assessment = YY%
Column O

19. Arrival to Theatre: National
Fig 13.2 – more likely to arrive in time out of hours

20. Arrival to Theatre: National v Local
National arrival in a timescale appropriate to surgery = 82.5%
Local hospital arrival in a timescale appropriate to surgery = XX%
Regional = YY%
Fig 13.2 – more likely to arrive in time out of hours
Data source = column P

21. Preop Consultant Input: National
For the first year NELA reports on different types of preoperative involvement – both face to face and in person are considered

22. Preop Consultant Input
National
Local
Regional
Both
85.7% XX YY
Surgeon
95.4%
Anaesthetist
88.8%
Intensivist (risk>10%)
67.5%
Key process measures;
The proportion of patients who had preoperative patient by a consultant surgeon, a consultant anaesthetist when predicted risk is >5%, a consultant intensivist (when risk >10%
Both = 85.7
Surgeon = 95.4
Anaesthetist = 88.8
Intensivist – 76.5%

23. Consultant Presence In Theatres: National

24. Consultant Presence In Theatres:
National
Local
Regional
Both
82.5% XX YY
Surgeon
92.3% yy
Anaesthetist
88%

25. Post op Critical Care: National

26. Post op Critical Care: Local
National
Local
Regional
Admission if risk >5%
79.3% XX yy
Admission if risk >10%
86.8%
Columns X and Z

27. Geriatric Review: National
National Mean = 22.9% of patients were seen by geriatricians
Remains low in this high risk group

28. Geriatric Review: Local results
Local geriatric reviews (proportion of patients) = XX%
Regional = YY%
Remains low in this high risk group
Column AA

29. Data to support shared decision making

30. Long-Term Mortality
First year

31. Discharge Destination

32. Antibiotics in Suspected Sepsis

33. Route of Admission & Admitting Specialty

34. Unplanned Events

35. Thank You
To everyone involved in caring for patients undergoing emergency laparotomy
To everyone involved in collecting the data