NELA+ is run by the Royal College of Anaesthetists’ Centre for Research and Improvement. The Clinical Effectiveness Unit of the Royal College of Surgeons of England are our partners and will provide important methodological and technical input as well as general advice on running national audits.

NELA+ is currently funded until 30th November 2027.

NELA+ includes all NHS hospitals in England, Wales, and Northern Ireland that carry out emergency laparotomy. This includes any hospitals with acute admission, emergency departments, or specialist centres which carry out emergency laparotomy as a complication of other types of surgery. Non-NHS hospitals and hospitals in Scotland, Republic of Ireland and Channel Islands do not currently take part in NELA+.

The NHS standard contract requires that organisations providing NHS care must participate in all relevant NCAPOP audits and enquiries. NCAPOP audits and enquiries are those commissioned by HQIP. If providers do not participate in relevant NCAPOP audits they will be in breach of their contract with their commissioner, therefore any non-participation would need to be agreed with the commissioner and CQC as the regulator.

NELA+ collects data on patients undergoing emergency laparotomy, or those considered for emergency laparotomy but who do not have an operation, in all eligible NHS hospitals in England, Wales, and Northern Ireland. Data is collected prospectively on all patients that fulfil the inclusion criteria. The aim of the audit is to generate data that drives quality improvement (QI). QI will be facilitated through dissemination of collected data as well as workshops and seminars to drive specific QI projects alongside data collection. Annual reports are published that provide detailed accounts of individual hospital outcomes.

• Generally, in the operative cohort, NELA+ includes all patients aged 18 or over, having a general surgical emergency laparotomy in an NHS hospitals in England, Wales, or Northern Ireland.

• The non-operative cohort includes patients aged 18 or over presenting with acute abdominal pathology needing surgical intervention, where a decision is made to not undertake surgery

• Detailed inclusion/exclusion criteria for the operative cohort can be found here.

• Detailed inclusion/exclusion criteria for NoLap can be found here. 

NELA+ collects basic demographic characteristics, like date of birth and sex as well as information about the processes of care (e.g. seniority of clinical staff in theatre, admission direct to critical care), and outcome measures (e.g. 30-day mortality, length of hospital stay).

Data is collected via an online data collection web-tool so that patient data can be entered directly into the audit database.

NELA+ is on the list of national audits for inclusion in Trusts' Quality Accounts. We issue annual reports that include key outcome data, identifiable at hospital level, adjusted for risk. We also provide comments on whether relevant standards are being met. We also issue monthly reports of hospital data to allow hospitals to make use of their most recent NELA+ data and to track their performance over time.

Emergency laparotomy is a complex clinical pathway that includes input from surgeons, anaesthetists, intensivists, physicians, radiologists, nursing staff, and other allied medical professions. All of these specialities will need to be aware of the audit and many will need to participate directly.

The RCoA cannot impose the allocation of SPA activity on hospitals.  However, it is our view that where a clinician is taking a lead role in the delivery of NELA+ within their hospital, this activity, provided it is diarised and incorporated into the job plan, is valid for inclusion in SPA activity.