NELA eNewsletter - 25th Edition December 2015

National Emergency Laparotomy Audit

Patient Data Collection

Tuesday the 1st of December officially marked the beginning of Year 3 of the NELA Patient Audit. We are very excited to be able to continue our work towards improving the quality of care received by patients undergoing emergency laparotomy and look forward to working with you over the next year. Remember NELA is an ongoing audit and so the process of capturing and entering patient data should remain the same as it has over the last two years.

This means that there is now less than a month until the deadline for entering, completing and locking all Year 2 cases for the audit. Friday 15th January 2016 is the last day on which hospitals will be able to submit patients they hope to have included in their Year 2 caseload; anything locked after that point will not be exported by the NELA Project Team and therefore not included in the Year 2 analysis and Report.

We strongly urge you therefore to spend the next four weeks going over both the cases on the NELA web tool to see if any remain incomplete and your hospital's theatre logs in order to determine if there are any qualifying procedures that have taken place over the last twelve months (procedures that took place from 1st of December 2014 until 30th of November 2015) that have not been entered onto the system.

Launch of the NELA QI Dashboard

The audit's Project Team is delighted to officially announce the launch of the NELA Quality Improvement Dashboard, currently found under the 'Reports' tab on audit's online web tool. This new function is now live and viewable by all NELA participants with access to the web tool.

Several months ago we launched the first phase of the dashboard which focused on data completion and Patient Demographics. While we heard from many of you that the Patient Demographics numbers provided in the Dashboard were useful, there was only so far they could go in helping to drive quality improvement. We have therefore spent the last few months working hard on developing the second phase of the Reports page, the QI Dashboard.

The QI Dashboard provides accurate and real-time data on what the NELA Project Team have deemed to be the most important process measures related to emergency general surgery. It reports specifically on:
• The interval between a decision being made to operate and patient's arrival in theatre
• Preoperative documentation of risk
• Consultant presence in theatre
• Direct admission to critical care following surgery (with particular attention being paid to high risk patients)

Like the Demographics side of the dashboard you are able to view both your local hospital results as well as the national averages to see how the two figures compare. You are also able to isolate results based on the date of admission, meaning if you would like to see the difference in process measures for Year 1 and Year 2 of the audit you can do so simply by using the date ranges tab. Remember a case will only appear in the QI Dashboard if it has been locked, meaning the more cases that are completed and locked on the system the more complete a picture the dashboard paints. We strongly urge you to have a look through the Dashboard's various screens in order to fully explore its capabilities and to encourage others in your departments to do the same.

New Hospital Resources on the NELA Website

Over the last few weeks we have added two new resources to the Documents page of the NELA website which we hope will prove incredibly useful for participating hospitals. The first is the Patient Audit Action Plan, following up on a similar document we released following the publication of our Organisational Audit in May 2014. The Action Plan will assist sites in ensuring that they are meeting the recommendations laid out in the Patient Report and if not, what actions need to be taken in order to achieve these aims.

The second document is our guide for calculating your hospital's observed/expected mortality ratio, found under the 'Resources for Hospitals' Documents subfolder. We have heard from many local NELA participants that while calculating their hospital's raw, in-patient mortality using the web tool export is useful, it doesn't provide any context for the mortality figure. The guide allows users to see how their mortality rate compares to the expected mortality based on preoperative risk assessment, thus giving users a much more accurate picture.

Both forms can be found under our Documents page, here.

NELA Helpdesk - Christmas Cover

The Royal College of Anaesthetists, out of which the NELA Helpdesk operates, will close for the Christmas and New Year break at 12.00 pm on Thursday, 24 December 2015 and re-open at 9.00 am on Monday, 4 January 2016. We will therefore not be able to address any telephone queries during this time.

We will however be providing cover for the NELA inbox on Monday 28 December and Thursday 31 December. Please feel free to email us with any questions you may have and we will do our best to respond via email during one of those two sessions. Full Helpdesk cover will resume on the morning of Monday 4 January 2016.

Upcoming Events Featuring NELA Speakers

The following events will also feature members of the NELA Project Team speaking about and answering questions on the audit:

Association of Anaesthetists of Great Britain and Ireland (AAGBI) Winter Scientific Meeting
13-15 January 2016, London
Dave Murray (Clinical Lead) Speaking & NELA Trainee Prize

Colorectal Anaesthetists Group UK Annual Meeting
25 April 2016, Manchester
Mike Bassett (NELA Research Fellow) Speaking

Association of Surgeons of Great Britain and Ireland (ASGBI) International Surgical Congress
4-6 May 2016, Liverpool
Iain Anderson (NELA Clinical Advisor) Speaking & NELA Trainee Prize

Association of Coloproctology of Great Britain and Ireland (ACGBI) Annual General Meeting
4-6 July 2016, Edinburgh
Iain Anderson (NELA Clinical Advisor) Speaking

To learn more about the work performed by clinical audit teams around the country we recommend you attend the 2016 Clinical Audit for Improvement Conference, taking place on Tuesday 8th March 2016 in London. For information about the conference and to book your place please click here.

Additional Useful Tools on NELA Website

Participant Manual - A compilation of all useful NELA background information and documents, the perfect introductory tool for a hospital user new to the audit
Audit Protocol Document - Provides an outline on the structure of the audit, as well as all professional stakeholders involved
Outlier Policy - Sets out the process by which participating hospital performance will be assessed and the process the NELA Project Team will follow to manage any hospital that is found to fall outside the expected range of performance and therefore flagged as an outlier
Organisational Audit Action Plan - Provides an action plan to assist hospital sites in ensuring they are meeting all recommendations laid out in the NELA Organisational Report
Set of Slides - A PowerPoint presentation focusing on the key findings of the NELA Organisational Report and how the report strongly emphasises the need for patient data to be collected and analysed
Top Tips - List compiled of some of the most useful and effective advice that was sent into us by a number of the top performing NELA sites
Frequently Asked Questions - Constantly updated FAQs reflect the most common and recent queries we receive from hospital staff and web tool users
Help Box Text - Provides additional assistance for filling in each of the data collection questions and can also be found on the web tool by clicking on the 'H' button to the right of every question
Proforma - A PDF copy of the latest Proforma, the online data collection questionnaire, that can be printed and filled out with patient information in real time, making it then easier to transfer all the information onto the online web tool
Updated Inclusion & Exclusion Criteria
NELA Poster & Leaflet - To publicise the audit amongst staff and patients in the hospital
OPCS Labels - For procedure items in the NELA dataset
Process Outcome Measures
Organisational Audit Link to Standards

Certificate of Participation

To receive your copy of the NELA Certificate of Participation please contact your hospital's Local Administrator to request that a certificate be issued for you.

Organisational Audit Report

To download a copy of the full NELA Organisational Report as well as the Executive Summary please click here.

Sign up to receive the NELA newsletter

The NELA project team will be regularly publishing a newsletter informing those interested and/or participating in the audit on the latest developments.

If you would like to receive the newsletter for regular updates please sign up to the mailing list here.

NELA Twitter

The National Emergency Laparotomy Audit has launched its own twitter account. This will provide updates, news and links to important information on the NELA website. You can follow us @NELANews

Key dates

• Complete: Organisational audit
• Jan 2014: 1st year of data collection for patient audit commenced
• May 2014: Organisational Audit Report published
• Dec 2014: 2nd year of data collection for patient audit commences
• June 2015: First Patient Report published
• Dec 2015: 3rd year of data collection for patient audit commences

Contact info:

If you have any questions or would like to contact the project team email -