NELA National Emergency Laparotomy Audit. Dr Liz Bright Consultant Anaesthetist, WSH Harold Youngman November 2015
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1 NELA National Emergency Laparotomy Audit Dr Liz Bright Consultant Anaesthetist, WSH Harold Youngman November 2015
2 Why do it? Emergency Laparotomy Network audit 2012 Variations in mortality
3 e 10-fold variation in outcome
4 Why do it? Emergency laparotomy network audit 2012 Variations in mortality Audit of HES (Hospital Episode Statistics) of high risk emergency general surgical admissions published 2013 Variations in mortality
5 Variation in outcome
6 ELN Audit Results % Admission to Critical Care 30 % Trusts
7 ELN Audit Results % Consultant Presence 40 % Trusts
8 National Emergency Laparotomy Audit To enable improvement of the quality of care through the provision of high quality comparative data from all providers of emergency laparotomy. Mandatory National Audit Section 251 approval patient consent NOT required Yearly reporting at hospital level
9 Audit against standards
10 Standards Relevant CEPOD documents quite old (1990s) 2011 documents Emergency surgery-standards for unscheduled surgical care The Higher Risk General Surgical Patient- towards improved care for a forgotten group
11 Recommendations High risk patients 10% 30 day mortality Two consultants in theatre (surgeon and anaesthetist) Post-op Critical Care Unit Patients aged over 70 Specialist input pre- and post-op Nutrition
12 NELA Phase 1: Organisational Audit Report published May 2014 Phase 2: Patient audit start 1 st Dec 2013 Now into the second year Funding now available for a total of four years- to Dec 2017
13 Inclusion Criteria Patients aged 18 years and over undergoing an expedited, urgent or emergency abdominal procedure on the gastrointestinal tract (England and Wales only) Open & laparoscopic Perforation, ischaemia, abdominal abscess, bleeding, obstruction. Bowel resection/repair due to incarcerated hernias Laparotomy/laparoscopy with inoperable pathology (e.g. peritoneal/hepatic metastases) Returns to theatre following emergency & elective surgery (including major dehiscence)
14 Exclusion Criteria Appendicectomy/Cholecystectomy unless incidental Diagnostic laparotomy/laparoscopy with negative findings Non-elective hernia repair without bowel resection. All other intra-abdominal surgery Vascular (except eg ischaemic bowel post-aaa repair) Renal Hepatobiliary Oesophageal Urology Obs & Gynae/ ectopic pregnancy Trauma
15 February 2013 at West Suffolk Hospital
16 Emergency Laparotomy guideline
17 Emergency Laparotomy guideline
18 Emergency Laparotomy guideline
19 Emergency Laparotomy guideline
20
21 Emergency Laparotomy guideline
22 WSH Trust Intranet page
23 PACU flexible overnight Level 2 care
24 The morning after the night before
25 NELA website
26 NELA data entry
27 Engagement- Trust Board
28 NELA data entry- surgeons
29 NELA data entry
30 Engagement
31 WSH Trust Intranet page
32 Engagement
33 Engagement
34 Engagement- anaesthetists
35 Emergency theatre
36 IOFM
37 IOFM
38 IOFM
39 NELA data entry
40 high quality comparative data
41 The First Patient Report of the National Emergency Laparotomy Audit (covers Dec 2013 to Nov 2014) Published June ,000 patients from 192 of 195 eligible NHS hospitals 30 day inpatient mortality 11% (awaiting independent verification from Office for National Statistics) This is 5 x greater than that for high risk elective surgery
42
43 Process measures- year one report
44 Next steps Funding agreed for a further two years (until Dec 2017) At WSH Appointment for care of the elderly physician Agreed job plan to include review of all emergency laparotomy patients over the age of 70 Consultant surgical review within 12 hours of hospital admission
45 Next steps Do getting the process measures right mean we are getting good outcomes? Watch this space
46 Next steps for me
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