The National Emergency Laparotomy Audit (NELA+) is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), overseen by the Healthcare Quality Improvement Partnership (HQIP).

The NCAPOP is a closely linked set of centrally-funded national clinical audit projects that collect data on compliance with evidence-based standards, and provide local trusts with benchmarked reports on compliance and performance. They also measure and report patient outcomes.

NELA was commissioned in 2011 by HQIP and is funded by NHS England and the Welsh government. NELA+ first began collecting data in 2013 and has continued to do so on a regular basis since. It was commissioned following evidence of a high incidence of death, and wide variation in the provision of care for patients in whom emergency laparotomy (emergency bowel surgery) is indicated. NELA+ collects data from eligible hospitals in England, Wales, and Northern Ireland. 

The aim of the audit is to enable the improvement of the quality of care for patients undergoing and not undergoing emergency laparotomy through the provision of high quality comparative data from all providers of emergency laparotomy. Beginning in 2024, NELA+ also started collecting data on a group of patients indicated for emergency laparotomy, but who do not have the surgery—the ‘NoLap’ cohort, with which NELA became NELA+.

The Royal College of Anaesthetists (RCoA) deliver NELA+ in collaboration with the Clinical Effectiveness Unit of the Royal College of Surgeons of England. The day-to-day management of the audit is guided by a project team, comprised of clinicians and methodologists. Formal oversight is provided by a Project Board consisting of key stakeholders. Scientific input is provided by a Clinical Reference Group consisting of representatives from all relevant clinical professional and speciality stakeholders (including patient groups).

To enable secondary care providers to improve the delivery of care to patients undergoing emergency laparotomy using information produced by the audit.

To provide comparative information on the organisation of care by providers of emergency laparotomy.

To provide comparative information on patient outcomes following surgery for emergency laparotomy.

To facilitate the development of effective change (quality improvement) initiatives and thereby spread examples of best practice and help local providers make the best possible use of audit results.

NELA+ publishes quality improvement plans for both emergency laparotomy and NoLap patients.

You can find more about how NELA+ is governed here.

If you have questions or concerns about the audit, please feel free to contact our helpdesk: NELA@rcoa.ac.uk.