National Emergency Laparotomy Audit The 5 th report

National Emergency Laparotomy Audit The 5 th report 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

5 th NELA report; 24, 328 patients • NELA Database now 160, 000 patients in total • 5 th Report published December 2019

Indications for Emergency Laparotomy

Surgical findings

Mortality: National

Mortality: Local 30 day risk adjusted mortality = XX %

Funnel Plot of risk adjusted ONS 30 -day mortality

Hospitals with the lowest 30 -day mortality

Length of Stay: National Lo. S = 16 days

Length of Stay: Local National Lo. S = 16 days Local Lo. S = XX days

5 th NELA report – the key standards

Data Ascertainment: National 178 hospitals were included in this metric. Overall case ascertainment was 84% (increased from year 4, 82. 7%). Overall 104 hospitals were rated green and 22 were red National case ascertainment – 84%

Data Ascertainment: Local 178 hospitals were included in this metric. Overall case ascertainment was 84% (increased from year 4, 82. 7%). Overall 104 hospitals were rated green and 22 were red National case ascertainment – 84% Regional case ascertainment = YY %

CT Reported before Surgery: National: 88% patients have a preoperative CT scan

CT Reported before Surgery: Local National: 88% patients have a preoperative CT scan Local results = XX % Regional results = YY %

CT Discrepancy Rates: National

CT Discrepancy Rates: National Overall discrepancy rate = 5. 3%

Preop Risk Assessment: National

Preop Risk Assessment: Local preoperative risk assessment = XX% Regional preoperative risk assessment = YY%

Arrival to Theatre: National arrival in a timescale appropriate to surgery = 82. 4%

Arrival to Theatre: local National arrival in a timescale appropriate to surgery = 82. 4% Local hospital arrival in a timescale appropriate to surgery = XX%

Preop Consultant Input: National

Preop Consultant Input: Local National Both 85. 7% Surgeon 95. 4% Anaesthetist 88. 8% Intensivist 67. 5% (risk>10%) Local XX XX Regional YY YY

Consultant involvement by risk category

Consultant Presence In Theatres: National

Consultant Presence In Theatres: local Both Surgeon Anaesthetist National 85. 5% 93. 7% 90. 1% Local XX XX XX Regional YY yy yy

Post op Critical Care: National

Post op Critical Care: Local National Admission if 77. 5% risk >5% Local XX Regional yy

Geriatric and frailty - National

Mortality and Lo. S – National (patients over 65)

Geriatric and frailty - Local geriatric reviews (proportion of patients) = XX% Regional = YY%

Assessment of frailty - National

Assessment of frailty - local Local frailty assessment (proportion of patients) = XX% Regional = YY%

Antibiotics in Suspected Sepsis Median time to antibiotics = 3. 5 hours in patients with suspected sepsis on admission 80% patients with sepsis required immediate or urgent surgery; 84% of these arrived in theatres in appropriate time frame

Unplanned Events; return to theatre 9% patients return to theatre 3% - planned 5. 4% unplanned

Unplanned admission to critical care

Sharing data with teams

The Recommendations

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