NELA Newsletter- 42nd Edition April 2018

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

Patient Data Collection

Data collection and data entry continues as we enter the 5th month of Year 5 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.

Quarterly Reports

The NELA Project team has published the 1st Quarter Individual Hospital Report for Year 5 of the patient audit.

Quarterly Reports contain local hospital data and which will allow hospitals to make use of their most recent NELA data and to track their performance over time.

The most recent report includes all cases taken to theatre between 1 December 2017 and 28th February 2018, regardless of whether they are locked or unlocked on the NELA webtool. You can find your Individual Hospital Report on the Webtool under the 'Reports' tab and then clicking on 'Hospital Reports'.You can then choose a Hospital and Report Type Click Here

Case Ascertainment RAG Rating

The NELA Project Team have an aim to constantly improve Case Ascertainment.
The RAG Colour Rating System boundaries have been updated from Year 4 patient audit were rating for cases being entered into the audit was 80% for higher performing hospital now it`s been changed to 85%.

The following figures below will be used to rate individual hospital progress in the NELA hospital progress list going forward.

Green= <85% of estimated caseload entered
Amber = 50%-84% of estimated caseload entered
Red = <50% of estimated caseload entered

Emergency Care Pathway Documents

In order to facilitate improvement in the delivery of care for patients undergoing an emergency laparotomy procedure through the dissemination of good practice a number of NELA participating hospital sites have shared supporting documents.

These pathway documents can be accessed on the website through the link provided below. Hospital are invited to adapt the pathways which have been provided in these document for their own purposes. NELA is unable to comment on the efficacy of these documents, as they are provided for information only.

Hospitals should monitor the implementation of these pathway in their own hospitals to ensure they achieve the desired effects.

Click Here for examples of pathway documents.

NELA Annual Report Feedback Request

Data analysis for the Year 4 patient audit is underway, and will soon be making preparations for the publication of the Year 4 report.

In order to create a report that is useful and accurate for both QI and QA purposes at a local and national level we would like to obtain your feedback. If you could provide us with some comments on the three questions below:

1.What do you like most about the NELA Annual Report ?
2.What changes would you like implemented in the next Annual Report ?
3.Any other concerns or comments you would like to share on pervious NELA Annual Reports ?

Please could you send through all your responses to the following email- info@nela.org.uk

NELA High Risk Patients Categorisation

The NELA risk calculator tool is available for use on the web tool and also in the NELA app. The P-Possum calculator also remains on the webtool, predominantly because it is familiar to most clinicians but it is anticipated that in time NELA will move on to use only the NELA risk tool.
The two tools do sometimes produce different scores to each other for the same patient, which has the potential to cause confusion. This difference happens because the NELA risk calculator has been solely designed and calibrated by using data from emergency laparotomy patients in NELA (as opposed to P-Possum).

A strength of the NELA model is that it has been developed using recent data from many different hospitals, which means that the patients on which it was developed are representative of the individuals having an emergency laparotomy.

In the clinical setting our recommendation has always been that whichever risk scoring systems are utilised, they should be used to complement clinical judgement. Risk assessment tools may be used to assess the individual risk of a patient but this must be done with caution and should only be used to support clinical judgement and aid discussions relating to appropriate care and not used in isolation. Even if a risk score is low, if a clinicians judgement is that the patient is a high risk case then the patient should be managed as a high risk case and care directed accordingly

For year 4 we will be calculating the RAG ratings separately for high risk patients identified by the NELA, P-Possum scores and clinical judgement. Hospitals will be credited with whichever provides the best performance for a single risk assessment method.
From year 5 onwards, high risk patients will be those identified by the highest score provided by NELA or P-Possum or clinical judgement. this means that a low risk patient is one whose risk is consistently identified as low by all three methods of identifying risk, i.e. NELA, P-Possum and clinical judgement all need to indicate that the patient is low risk. If data is missing for any particular score the patient will be assumed to be high risk.

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.

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 "Webtool". 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

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
31st 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