Options for anaesthesia and all aspects of perioperative care, including risks and benefits, should be discussed with the patient by the responsible anaesthetist.35
The IPS should consider facilitating anaesthetists in training to participate in inpatient pain audits and research as part of their training.57
Anaesthetists should actively engage in planning services with significant regional anaesthesia requirements. They should be actively involved in policy decisions, service improvements and equipment purchasing related to regional anaesthesia.
The National Emergency Laparotomy Audit (NELA) has been a real success story – engaging with clinical teams and feeding back high-quality comparative process and outcomes data to improve care.1,2,3 As NELA enters its second decade, it is important to look at persisting challenges as well as successes, and consider where improvement efforts should now be concentrated. This article highlights three areas of emphasis from Year 10 (2023) of the audit.
Successive NELA reports have highlighted failings in this area – with many patients recorded as having sepsis at admission and/or at time of the decision to operate (DTO), but seemingly poor timeliness of care in terms of both antibiotic administration and definitive source control. Closer examination reveals potentially missed opportunities to streamline decision-making ‘upstream’ of the DTO. Year 8 data3 shows that the median time from arrival in hospital to arrival in theatre for those with sepsis at time of arrival was 15.6 hours. Fewer than a quarter of those with sepsis on arrival at hospital received antibiotics within an hour. This finding might be partially explained by an over-interpretation of the term ‘sepsis’.
