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14th May 2014

Publication of NELA Organisational Report

First-ever National Emergency Laparotomy Audit begins process of improving delivery of care

The First Organisational Audit report of the National Emergency Laparotomy Audit outlining the results, conclusions and recommendations from the audit was published on the 14th May 2014.

The report is available for download from the reports section of the NELA website.

Improved facilities and better teamwork could help to improve the care received by patients who undergo an emergency laparotomy in England and Wales, according to the first stage findings of the inaugural National Emergency Laparotomy Audit (NELA) published today.

Previous studies have identified that patients undergoing emergency laparotomy - the term for emergency surgical procedures to treat life-threatening abdominal conditions - have a high risk of death and serious complications following surgery. Of the 30,000 procedures performed annually there is an estimated 15% mortality within the first month following surgery.

This first stage NELA report investigated the structures and processes in place for emergency abdominal surgery at 190 hospitals in England and Wales, with patient-level data to be reported for the first time in summer 2015.

The clinical audit examined the availability of resources fundamental to the effective care of emergency laparotomy patients and found wide variations across hospitals. The report found that whilst many hospitals meet current standards of care, there are some areas where improvements could be made to help ensure that all patients who require an emergency laparotomy receive the highest standard of care.

Key findings indicate that:

  • Four-fifths of hospitals admitting unscheduled adult general surgical patients provide one or more fully staffed operating theatres in which emergency laparotomy may be performed at all times.
  • Only nine out of ten hospitals have 24 hour CT reporting available.


  • There are diverse levels of clinical staffing in place, which may have an impact on the delivery of care. Patient level data will be essential in clarifying this.
  • The implementation of clinical pathways for the care of patients undergoing emergency laparotomy varies widely across hospitals.

  • Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme NELA is being carried out by the Royal College of Anaesthetists (RCoA) on behalf of surgeons, anaesthetists and other doctors and healthcare professionals.

According to Dr Dave Murray, NELA National Clinical Lead and Consultant Anaesthetist, James Cook University Hospital, the potential health impact of an even modest improvement could be substantial. "This work is a big step forward as it is the first time that the quality of care for emergency laparotomy patients has been looked at in such a systematic way and at a national level. We have had one hundred percent cooperation from hospitals, which demonstrates the readiness of clinicians and managers to engage with these challenging issues. This engagement together with data from patients who have had emergency laparotomy surgery will help us to identify the gaps in care provision that need to be addressed."

Iain Anderson, NELA National Surgical Advisor, Association of Surgeons of Great Britain and Ireland explained: "Care of the emergency laparotomy patient involves an extremely complex clinical pathway. Our report compares delivery of care against standards drawn from a variety of specialist reports. If all these recommendations are implemented, there should be an immediate impact on patient care. Throughout this audit, we hope to see clinicians and managers across specialties working to offer local quality improvement programmes based on the prioritisation of patient needs and the best use of resources."

NELA is being carried out by the National Institute of Academic Anaesthesia's (NIAA) Health Services Research Centre on behalf of the Royal College of Anaesthetists (RCoA). The Audit is being run in collaboration with the Clinical Effectiveness Unit of the Royal College of Surgeons of England and the Intensive Care National Audit & Research Centre.

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