Presentation by Dr Nick Lown, Consultant Anaesthetist and Perioperative Medicine Lead, Aintree University Hospital at the Emergency Laparotomy Collaborative event on Monday, 17 June at The Foresight Centre, Liverpool.

1. Some NELA
data
insights
Dr Nick Lown
FRCA MBChB(Hons) BSc PgCert

2. Outline
• Introduction to the data
• Risk prediction tools
• Patient overview
• Mortality overview
• Tariff standard achievement

3. Transparent
Reproducible
Shareable
Analysis methods

4. • Volume
• Velocity
• Variety
• Veracity
• Value
5 V’s of Big Data

5. 8 hospitals
1693 patients
254 data points per patient
430,022 total data points
Data volume

6. Data Completeness

7. Data Value
Reduce
mortality
NELA report 2018 – national
mortality 9.5%
Best practice
Tariff
Enhanced tariff ≈ basic + £700
Only if >80% meet 3 core metrics
Achievement based on NELA data
Deliver best
care
Responsibility to patients

8. Hospital name
Date of entry into theatre
Preop risk assessment
completed
Preop mortality
assessment (P-Possum &
NELA risk calculation)
Intra-op anaesthetist
Post-op destination
Outcome – day 30
Metrics used

9. Outcome day 30
Day 30

10. Risk
prediction
tools

11. Mortality prediction tools
73 % of patients had a formal preop
mortality risk assessment

12. Mortality prediction tools
P-Possum predicted mortality

13. Mortality prediction tools
“P-Possum overestimates risk”
“They’re not for individual
prognostication”“They’re just for
looking at
populations” “Experienced clinicians
just ‘know’”

14. Mortality prediction tools
NELA risk tool predicted mortality

15. General
demographics

16. Patient distributions

17. Patient distributions

18. Patient distributions

19. Patient distributions

20. Patient distributions

21. Mortality
distribution

22. Mortality distribution
30 day survival

23. Mortality distribution

24. Cumulative mortality
0 / 4 = 0%
1 / 5 = 20%
1 / 8 = 12.5%
4 / 14 = 29%
Predicted mortality

25. Cumulative mortality

26. Cumulative mortality

27. Cumulative mortality

28. Cumulative mortality

29. The
tariffon

30. Tariff achievement

31. Tariff achievement

32. 792 patients with mortality risk
>5%
735 did not meet BPT
Represents loss of ≈ £514,500
Tariff achievement

33. Tariff standards
30 day survival

34. Tariff standards
30 day survival

35. Tariff standards
30 day survival

36. Tariff standards
30 day survival

37. Tariff standards

38. Tariff standards

39. Tariff standards

40. Summary
• Meeting BPT targets offers significant financial gain
to the region
• Laparotomy resources need to target ‘less sick’
patients
• Mortality prediction tools are key to this
• Emergency laparotomies are a condition of older
patients

41. Discussion