NELA Newsletter - 35th Edition April 2017

Welcome to the National Emergency Laparotomy Audit's e-Newsletter.

Patient Data Collection

Data collection and data entry continues as we enter the 6th month of Year 4 of the patient audit. The Project Team are pleased with the ongoing hospital participation and would like to thank all those who are contributing to the audit.

It is important to ensure that the cases being entered are also being completed and locked. Remember a patient can only be included in the audit if their case on the web tool is locked, meaning that all cases that remain "incomplete" on the system will go to waste. One of the biggest lessons we have learned over the last year is that entering patient data is easier when done in real time, rather than having to chase patient information retrospectively, often after the patient has been discharged.

As always if there is anything the Project Team can do to assist with the data collection process, whether it be adding new users onto the web tool or answering question about the inclusion/exclusion criteria, please don't hesitate to let us know.

Quarterly Reports

We are currently piloting the production of quarterly hospital summaries. The aim is to produce reports similar to the annual Individual Hospital Progress Report, at the end of each quarter. This will allow hospitals to make more frequent use of their recent NELA data to track their performance over time. As this is the pilot, the reports will not be made available on the NELA website and we would welcome any feedback from hospitals. It is the aim that future versions will be made publically available via the NELA website. Please contact the NELA Help Desk if you need any additional information.

Inclusion / Exclusion Criteria Changes

We have recently updated our Inclusion/Exclusion criteria with the following changes:

  • Not having an NHS number no longer automatically excludes you from the Audit. If you have a patient who doesn't have an NHS number, please get in touch with us.
  • We have clarified the criteria with respect to reoperation/return to theatres. This means that many patients who returned to theatre for complications of non-GI surgery are now excluded:
    • Patients returning to theatre for ischaemic bowel following elective or emergency aortic aneurysm surgery, or for ischaemic bowel following cardiac surgery
    • Patients requiring non-elective GI procedures following prior gynaecological surgery
    • Patients returning to theatre for post-operative complications (e.g. bleeding, sepsis) following prior urological/renal surgery (except transplant)
    • Patients requiring any non-elective GI procedures as a return to theatre following any other elective or emergency procedure (even if the original procedure would have been excluded)

These changes will apply to any patient yet to be entered into NELA and we are currently clarifying how best to deal with patients that have already been entered into NELA since 1st December 2016.

We are required by HQIP to continually to address the problem of data collection burden put on hospitals. Some of the new exclusions are regarding cases that will be picked up by other Audits and may affect hospital case ascertainment figures. We will be shortly releasing a new set of figures to account for this.

The new criteria has been updated on our website under "FAQ's." and on the web tool . As always the criteria on the Inclusion/Exclusion list is not exhaustive. Please contact the Project Team if you have any questions or need any clarification.

Quality Improvement Videos

We have launched our third NELA Quality Improvement videos, titled "NELA: understanding the system." All three videos are listed below and can be watched on this
playlist:

1. "Using run charts to drive quality improvements with NELA data"
2. "Using NELA for Quality improvement"
3. "NELA: understanding the system"

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 (new) - 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.

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

•December 2014: 2nd year of data collection for patient audit commenced
•June 2015: First Patient Report published
•July 2016: Second Patient Report published
•1st December 2016: 4th year of data collection for patient audit commenced
Autumn 2017: Third Patient Report will be published
•November 2017: end of year 4 Audit

Contact info:

If you have any questions or would like to contact the project team email - info@nela.org.uk