Presentation by Dr David Raw, Deputy Divisional Medical Director, Aintree University Hospitals NHS Foundation Trust at the Emergency Laparotomy Collaborative, 13 November 2018 at Bolton Whites Hotel.
2. On the menu today…
13:30 Introduction: NELA update and NW performance
Dr David Raw Anaesthetist
13:40 The ELC: KSS perspective
Jo Wookey- Improvement Lead
14:00 What’s working well locally?
Mr Paul Goldsmith UGI Surgeon
14:20 Importance of data
Dr David Raw
14:30 Supporting data collection and analysis
Dr Matt Bridge Anaesthetist
14:40 Round table discussion
15:40 Patient Safety Collaborative
Ass. Directors Andrew Cooper (Innovation Agency)
and Jay Hamilton (Health Innovation Manchester)
16:00 Close
3. NELA
• Centrally funded National Clinical Audit Project
• Aim to improve care through high quality
comparative data between hospitals
• Contract for provision of NELA won by RCOA 2012.
Data collection commenced Dec 2013.
• Data collection describing processes and outcomes
• Compared to standards of care
• 4 annual reports 2015, 2016, 2017, 2018
• 4th report published 8th Nov 2018 (2016-17 data)
4. Number of standards being met
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NumberofhospitalsratedGreen
5. Number of standards being met
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6. Number of standards being met
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12. Introduction of new Best Practice Tariff
2019/21
For high risk EL patients (mortality >5%?)
>80% of eligible patients (NELA data) must receive BOTH:
• Consultant Surgeon and Anaesthetist presence in theatre
for high risk cases
– NW data: 11/25 Trusts with <85% of cases (amber/red rated)
• Critical care admission from theatre for high risk cases
– NW Data: 11/25 Trusts with <85% of cases (amber/red rated)
15/25 Trusts are amber/red rated for one or other of
these metrics.
The 4th report collected data form 25,000 cases of the 30,000 emergency laparotomies performed in England and Wales.
182 Trusts
Improvements seen during the course of the audit in LoS and 30-day mortality.
The 3rd report collected data form 24,000 cases of the 30,000 emergency laprotomies performed in England and Wales.
Improvements seen during the course of the audit in LoS and 30-day mortality.
183/191 hospitals in England and Wales
Patients more likely to arrive in theatre within accepted time frame at night. ?pressures of flow during the day??
There appears to be a variation in outcme measures.
NHSi and NHS England appear to be impatient for QI in Emerg Lap care….