NELA eNewsletter - 26th Edition March 2016

National Emergency Laparotomy Audit

Patient Data Collection

Friday the 29th January was the deadline for all cases for Year 2 of the Patient Audit to be completed and locked. There was an incredible amount of work done in those last few months from a large number of hospitals to ensure that as many eligible cases were submitted as possible. Following the deadline the data was exported and cleaned by the Project Team; we are now happy to report that we have rough 23,100 Year 2 patient cases, over 3,000 more that we had for Year 1. This is entirely down to the incredible work performed by the Local Leads, so we would like to once again extend our deepest thanks to them for their efforts.

Tuesday the 1st of December officially marked the beginning of Year 3 of the NELA Patient Audit. 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. Those of you who received the monthly Progress List last week will have noticed that the case ascertainment targets have changed for Year 3, with the rating criteria having shifted. A Green rating will now require a case ascertainment rate of over 80%; at the same time hospitals will be rated Red if they have a case ascertainment rate of less than 60%. This is due to a change in the NELA contractual targets for Year 3, with the audit required to collect data for 80% of all qualifying patients. The final case numbers for Year 2 of the Patient Audit put us just above our target of 70% of cases, a number we were incredibly pleased with. With the target now changing however we are going to be making an even bigger push to ensure that all eligible procedures are added onto the system and completed.

NELA and the CQC

Towards the end of 2015 the NELA Project Team was approached to participate in an HQIP/CQC initiative whose aim is to provide audit data that will feed into specific metrics that will be used by the CQC and their review process. The Project Team have submitted seven draft NELA metrics that may form part of the CQC work. The seven draft metrics are:

• Case ascertainment
• Preoperative documentation of risk
• Arrival to theatre within the timeframe set out
• Consultant surgeon presence for high-risk patients
• Consultant anaesthetists presence for high-risk patients
• Direct postoperative admission to critical care for high-risk patients
• Risk-adjusted mortality

We will confirm the finalised metrics in the next few months.

Using the Export Function on the NELA Web Tool

We have heard from a number of NELA Leads over the past several months how useful they have found the NELA QI Dashboard to be, particularly for increasing clinical engagement in the audit. The ability to see real-time process measure data has been a huge catalyst for local Quality Improvement initiatives. We are delighted the Dashboard is proving to be beneficial and we hope to build on this by increasing the number of process measures it reports on in the future. The Project Team would like to continue to stress the importance of using the web tool's export function.

The export function remains the most useful tool in performing in-depth data analysis on a local level. It allows you to examine the effect of preoperative risk on the perioperative process, focus on the effectiveness of key process measure and to then link those process measures to in-patient mortality. It is crucial that the export be viewed alongside the Export Key; a guide that explains which column on the export spreadsheet each Proforma question corresponds to, as well as what answer option each export code represents. The Export Key can be found under the Support tab on the web tool and under the Documents page on the website.

To access the export function simply select the Export option under the Clinical tab on the web tool. If you find that the Export option isn't there, simply get in touch with the NELA helpdesk to request your account be granted Reporter Privileges.

NELA Outlier Policy

The NELA Project Team has now received the mortality data from the Office for National Statistics, and will therefore be analysing and publishing hospital level mortality. Should a participating hospital be identified as an outlier, there is a procedure set out in the DH/HQIP outlier policy that all national audits are contractually obliged to follow. This provides hospitals with the opportunity to review their existing data and correct any inaccuracies. The outlier policy also includes a requirement to inform your Medical Director and Chief Executive of potential outlier status.

The timeframes for this, set out in the outlier policy found in the Documents page on the website, and some are relatively short (i.e. 25-30 days in total). It is likely that patient notes will need to be obtained in order to review the submitted data, meaning it is therefore important that the relevant staff is available to undertake these tasks within the required timeframes. If you are a NELA Lead for your hospital therefore we would be grateful if you could ensure that, should key members of staff be away (e.g. on leave/holiday) over the next two months, that alternative staff have been identified and nominated to carry out this important review.

Unfortunately we are unable to delay publication of the report should hospitals not review their data within the specified timeframes. Failure to follow up on the opportunity to review existing data will still result in publication of a hospital's results.

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:

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

Age Anaesthesia Association (AAA) Annual Conference
26-27 May 2016, Derby
Mike Bassett (NELA Research Fellow) Speaking

Midland Society of Anaesthesia (MSA) Meeting
17 June 2016, Birmingham
Mike Bassett (NELA Research Fellow) Speaking

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

Additional Useful Tools on NELA Website

Guide for calculating observed/expected mortality ratio - Instructions for calculating how your hospital's in-patient mortality rate compares to the expected mortality based on preoperative risk assessment
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
Patient and Organisational Audit Action Plan - Provides an action plan to assist hospital sites in ensuring they are meeting all recommendations laid out in the NELA Patient and Organisational Reports
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 commenced
• June 2015: First Patient Report published
• Dec 2015: 3rd year of data collection for patient audit commenced
• June 2015: Second Patient Report to be published

Contact info:

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