Fourth Patient NELA Audit Report Published

A new study from the Royal College of Anaesthetists around improvements in the care of patients before, during and after emergency bowel surgery shows enhanced patient care has led to the national 30-day mortality rate falling from 11.8 per cent to 9.5 per cent over the last four years. This represents approximately 700 patients’ lives saved this year compared to 2013.

Known as an emergency laparotomy, this surgery is one of the highest risk operations a patient can undergo, with nearly 24,000 people needing this urgent life saving operation each year. RCoA’s National Emergency Laparotomy Audit (NELA) report, also found that patients’ average hospital stay has reduced from19.2 days in 2013 to 15.6 days in 2017 saving the NHS an estimated £34 million annually.

The audit identifies improvements in care have been achieved in the following areas:

• 75 per cent of emergency laparotomy patients received an assessment of risk (up from 71 per cent in 2015, and 56 per cent in 2013)
• 95 per cent of patients undergoing emergency laparotomy surgery saw a consultant surgeon and 89 per cent saw a consultant anaesthetist before their surgery
• 83 per cent of patients had a consultant surgeon and anaesthetist directly looking after them whilst they had their emergency surgery – the highest level since the first audit results in 2013; for high and highest risk patients a consultant surgeon was present during surgery 92 per cent of the time, a consultant anaesthetist 88 per cent
• 87 per cent of the highest risk patients were admitted to critical care following surgery.

Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the fourth annual National Emergency Laparotomy Audit report analyses the care received by approximately 24,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2016 and November 2017. It is based on data collected by teams at 183 hospitals in England and Wales.

While there have been improvements in key areas of patient care, some hospitals fall short of the standards referenced within the NELA report. Examples of areas where more improvement is still needed include:

• only a quarter of patients who had signs of sepsis on admission received antibiotics within the recommended 60 minutes
• almost half of all patients were aged over 70, yet more than three-quarters did not receive regular pro-active assessments from geriatricians after surgery
• the proportion of patients arriving in the operating theatre within appropriate timeframes has remained static at 82 per cent (almost unchanged since 2013). Of greater concern is that the figure for the most urgent patients (requiring surgery within 2 hours) has fallen from 76 per cent to 73 per cent
• while intraoperative consultant presence is at its highest-level overall, out-of-hours presence remains lower. Consultants are present for 83 per cent of the time in daytime hours, compared to less than 68 per cent after midnight. This is particularly concerning given that a greater proportion of high-risk and highest-risk patients have surgery between 6.00pm and 8.00am.

Professor Ravi Mahajan, President of the Royal College of Anaesthetists, said:

“The latest NELA report highlights how clinicians across specialties are continuing to work together to deliver sustained improvement in patient care and saving lives.

“Working to NELA’s recommendations, the amount of time patients stay in hospital is being reduced year-on-year. This not only aids patient recovery but also delivers a significant financial saving for the NHS.”

Dr Sarah Hare (NELA National Clinical Lead):

“Clinical teams have been working seven days a week, twenty four hours a day to ensure that their patients having emergency laparotomies receive the best care possible.

“The results from NELA demonstrate how this has improved the outcomes for patients. With increasing pressures on services though, the challenge is to now enable and support these teams with appropriate resources and time so they can continue this work. "

Russell Prestwich, emergency laparotomy patient said:

“I have now had two emergency laparotomy surgical procedures this year.

“The first time, I was unaware of what it was until after the surgery, but as it was an emergency things had to happen quickly. 

“It is important for patients and relatives to know the level of complexity in this surgery and NELA supports clinicians to be able to talk about this with their patients."

The full fourth Patient NELA Audit Report is available online at: www.nela.org.uk/reports