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The Second Patient Report of the National Emergency Laparotomy Audit

The Second Patient Report of the National Emergency Laparotomy Audit. www.nela.org.uk info@nela.org.uk. NELA Aims. To improve the quality o f care provided to patients undergoing emergency laparotomy through provision of high quality data Facilitate local quality improvement

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The Second Patient Report of the National Emergency Laparotomy Audit

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  1. The Second Patient Report of the National Emergency Laparotomy Audit www.nela.org.ukinfo@nela.org.uk

  2. NELA Aims • To improve the quality of care provided to patients undergoing emergency laparotomy through provision of high quality data • Facilitate local quality improvement • Provide comparative data at hospital level to allow identification of high performing sites • Only reporting at hospital level • emergency laparotomy care is a “team game” • clinician level reporting is not appropriate

  3. Year 2 (Dec 2014-Nov 2015) • 23000+ patients (70%) from 186 hospitals • Some things have improved • Personal practice • Some have yet to improve • Organisational change • Still considerable variation 3

  4. Improvements seen in: • Case ascertainment 70% from 65% • CT scanning & reporting 72% from 68% • Preop risk assessment 64% from 56% • Consultant surgeon and anaesthetist presence in theatre 70% from 65% • High risk patients • Consultant anaesthetists present 82% • Consultant surgeon present 89% • still differences between “in” & “out of hours”.

  5. Risk Assessment56% vs 64% Assessment, appreciation and communication of risk leads to better standards of care

  6. P-POSSUM calibration

  7. Risk of death and observed ONS 30-day & 90-day mortality

  8. Consultant presence & critical care admission according to risk

  9. Consultant presence (>5% risk)

  10. Critical care admission 83% vs 85%

  11. Yet to improve • Antibiotic administration: 20% did not get pre-op • Delays to theatre: 70% of most urgent patients • Critical care for highest risk patients remained ~85% • Elderly care input only 10%

  12. Proportion of hospitals meeting standards

  13. Number of standards being met Number of hospitals rated Green Number of standards met

  14. Number of standards being met Number of hospitals rated Green Number of standards met

  15. Outcomes

  16. ONS 30-day and 90-day mortality by age group (Year 1 and Year 2 data)

  17. Funnel plot of risk-adjusted ONS 30-day mortality (Year 1 and Year 2 data)

  18. Trend in the overall ONS 30-day & 90-day mortality

  19. Length of Stay: £200 million + Mean LOS 18.1 days  16.3 days £22 (€30) million savings

  20. Other outcomes

  21. Hospital level figures

  22. National Emergency Laparotomy Audit? Quality Improvement Project Share Best Practice http://nela.org.uk/Pathway-Examples#pt NELA QI dashboard generates real-time charts that show change over time

  23. Summary Thank you for: • 43000+ patients since the audit started • improvement seen at personal level Risk Assessment drives resources Need organisational change Not “National Audit”, but local Quality Improvement

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