NELA Newsletter - 39th Edition December 2017

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

Patient Data Collection

Year 4 of the patient audit data collection period ended on 30th November 2017. 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. The biggest lessons we have learned while auditing 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.

Our Fourth Patient Report will focus on procedures that took place from 1st December 2016 until 30th November 2017 and we are giving hospitals until Monday 22nd January 2018 to ensure that all these cases are locked and exportable by the Project Team.

Therefore, over the next few weeks please go through your hospital's incomplete cases and to complete and lock as many of them as possible. Many of you will also have patient cases that are eligible for inclusion but have not yet been entered on the web tool; it is imperative that these are also included and completed as soon as possible so that you have time to lock them before the January deadline.

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.

Year 5 Patient Audit

The Data collection period for Year 5 started on Friday 1st December 2017 and will be continuing on until 30th November 2018.

As with previous years some minor changes have been applied to the web tool as of the 1st December 2017 for Year 5 dataset. This included changes in wording of the questions - If you use paper proforma copies to collect your data please update it by printing out the new version from the 'Support' menu on the Webtool.

An option for NELA Local Administrators to Enable/Disable some Quality Improvement questions on the webtool was initiated. By default, the Quality Improvement (QI) questions on the NELA Webtool are enabled. However if you do not wish to collect data for one or more QI questions, the questions can now be disabled for a specific time period. A set of Help Notes (QI Questions Help Notes) on how to do this can be downloaded from the 'Support' tab on the NELA Webtool.

NICE Consultation - NICE quality standard: Emergency and acute medical care in over 16s

We would like to announce that the National Emergency Laparotomy Audit participated and contributed in the NICE consultation for the NICE quality standard in Emergency and acute medical care in over 16s

The following issues raised are:

1.Prompt recognition and referral to surgery, of patients admitted under acute medicine who may have acute intra-abdominal pathology
2.Identification and treatment of sepsis regardless of admitting specialty or pathology
3.Early senior review of patients with a potential high risk of death, including those who deteriorate, rather than waiting until the next scheduled ward round.
4.Ensuring patient centred outcomes are reflected in the quality standards.

NELA Local Teams Progression

Nela data collection can be a laborious task, especially around the winter season just before the January deadline for locking cases. However, for a NELA local team in Leeds who took an initiative and decided to engage with a manager within their multidisciplinary team, since then there has been some considerable changes .

To read more about how the Leeds team made changes to improve their National Audit participation please read more via the link below:
NELA team progression in Leeds

NELA APP

The NELA App has been updated with the most recently published report and data and is available for downloading on both Apple and Android devices using the Links below. On this application you will be able to access the risk calculator and NELA reports.

•Android here.
• iOS - here.
•To read more about click here.

Hospital Progress Reports

Every month we send out the NELA Hospital Progress List. This document provides a snapshot of a hospital's status in relation to overall case ascertainment and will show different figures from the quarterly reports.

As always, we hope this list proves useful in providing you with an overview of the number of cases you have entered on the NELA web tool over the last few months, as well as how complete this data is and how the numbers compare to your expected caseload.

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 on Friday, 22 December 2017 and fully re-open at 9.00 am on Tuesday, 2 January 2018.

The NELA Email help desk will be open for 2 mornings during this period - Wednesday 27th December and Friday 29th December. We will do our best to answer any queries in the NELA Inbox on those days.

Do feel free to email us with any questions you may have and we will do our best to respond via email when full helpdesk operation resumes on the morning of 2nd January 2018.

Inclusion / Exclusion Criteria Changes

The NELA Inclusion/Exclusion criteria were updated in April. If you have not had a chance to familiarise yourself with these changes please check the new criteria 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 Regional Workshops

There has been four Regional Quality Improvement workshops events which have been carried out successfully thus far. We would like to thank all the candidates who have attended these events and participated in discussions and interactive sessions set on the day.
We have been gathering feedback from all the events which will take on board when organising future workshop meetings.
Presentations given at the workshops and hand out materials can be accessed and downloaded through the link provided below:
NELA QI Workshops Material

Quality Improvement Videos

The popular NELA Quality Improvement videos are all available on our youtube channel. All three videos are listed below and can be watched on this playlist: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

•June 2015: First Patient Report published
•July 2016: Second Patient Report published
•October 2017: Third Patient Report published
November 2017: end of year 4 Audit
•1st December 2017: 5th year of data collection for patient audit commenced
22nd January 2018 Case Lock Deadline

Contact info:

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