Patient Audit Overview

Data collection for the NELA Patient Audit process is currently taking place, continuing on an annual cycle from 1 December one year to 30 November the following year.

• All patients over the age of 18 years, having a general surgical emergency laparotomy in all NHS hospitals in England and Wales are eligible for inclusion and will be enrolled on a prospective basis. There is the potential to include the Devolved Nations should their funding bodies choose.

• The aim is to include all emergency gastrointestinal procedures on the stomach, large and small bowel, for conditions such as perforation, bleeding, abdominal abscess or obstruction, via open or laparoscopic approaches. Emergency laparotomies following elective surgical complications will also be included in the NELA.

• Patients requiring vascular surgery, gynaecological surgery, surgery on the renal tract, and laparotomy following trauma will be excluded.

• If the original procedure was a non-elective laparotomy and this has been captured in the audit, then we will only be collecting a minimal amount of perioperative data for subsequent returns to theatre.

• If the original procedure was not included in the audit (e.g. because it was an elective procedure, or initially excluded from the audit), then the return to theatre will need to be included as it is a "new" emergency laparotomy.

To see the exact full inclusion / exclusion criteria click below:

The NELA dataset is available online. Prior to release, the dataset is reviewed by the Clinical Reference Group, and piloted by users to ensure feasibility. NELA aims to collect only the minimum information required in order to provide risk adjusted comparisons against existing standards of care. We appreciate that the success of NELA depends on clinical engagement, and do not intend the dataset to be too onerous. No additional tests or investigations are required. All information collected is that normally available in the delivery of care to patients undergoing emergency laparotomy. Where possible, we link to existing databases to reduce the burden of data collection.

Data collection is prospective on all patients that fulfil the inclusion criteria. Data is primarily collected in theatre and at discharge.

Data collection will take place via the NELA online web-tool.

All data entry is carried out through the online data collection web-tool, which is accessible via PC, tablets and mobiles.

This audit is a continuous prospective audit with real time data collection. It is expected that clinical teams enter the data in real time rather than retrospectively.

More than one person can enter data on a particular case.

There will also be a paper form that you can download to use as assistance, but the data will have to be entered online.

All sections need to be complete for the audit data to be submitted.

We issue annual reports that include key outcome data, identifiable at hospital level. These will be adjusted for risk. We will also provide comments on whether relevant standards are being met. A Public & Patient Guide will be made available to accompany the annual reports.

We also produce quarterly reports at hospital- and AHSN-level so that hospitals can track their progress against key performance metrics on an ongoing basis.

The aim of the audit is to generate comparative information that drives Quality Improvement (QI). QI will be facilitating through dissemination of collected data as well as workshops and seminars to drive specific QI projects alongside data collection.

The NELA webtool allows for participating hospitals to view data on key metrics, like mortality and sepsis, in real-time. This information can help support local quality improvement initiatives.

NELA is currently funded by HQIP until 30 November 2022, with the potential to continue for further years beyond this. There is no subscription to be paid in order to participate in NELA; the data entry web-tool is provided at no cost to participating hospitals within England and Wales. All data is analysed by NELA and results provided to hospitals at no cost. Hospitals will need to cover the actual cost of data collection themselves, however because NELA also includes an element of Quality Improvement activity, we would anticipate that there will be a benefit to Trusts as the quality of care improves.

NELA is one of the NCAPOP (National Clinical Audit and Patient Outcomes Programme) audits funded by the Department of Health through HQIP. The NHS standard contract requires that organisations providing NHS care must participate in all relevant NCAPOP audits and enquiries. If providers do not participate in relevant NCAPOP audits they will be in breach of their contract with their commissioner, therefore any non-participation would need to be agreed with the commissioner and CQC as the regulator.
Further information is available on the HQIP website.
https://www.hqip.org.uk/national-programmes/quality-accounts/#.YAbi8uj7Q2w
https://www.hqip.org.uk/wp-content/uploads/2018/05/Guidance-on-Quality-Accounts-January-2018.pdf
https://www.hqip.org.uk/resource/hqip-statutory-and-mandatory-requirements-in-clinical-audit-guidance/#.YAbjLej7Q2x