Presentation by Dr David Raw, Deputy Divisional Medical Director, Aintree University Hospitals NHS Foundation Trust at the Emergency Laparotomy Collaborative, 13 November 2018 at Bolton Whites Hotel.

1. Quality Improvement
for
Emergency Laparotomy Care
in the Northwest
Dr David Raw
Consultant Anaesthetist
Aintree University Hospital

2. On the menu today…
13:30 Introduction: NELA update and NW performance
Dr David Raw Anaesthetist
13:40 The ELC: KSS perspective
Jo Wookey- Improvement Lead
14:00 What’s working well locally?
Mr Paul Goldsmith UGI Surgeon
14:20 Importance of data
Dr David Raw
14:30 Supporting data collection and analysis
Dr Matt Bridge Anaesthetist
14:40 Round table discussion
15:40 Patient Safety Collaborative
Ass. Directors Andrew Cooper (Innovation Agency)
and Jay Hamilton (Health Innovation Manchester)
16:00 Close

3. NELA
• Centrally funded National Clinical Audit Project
• Aim to improve care through high quality
comparative data between hospitals
• Contract for provision of NELA won by RCOA 2012.
Data collection commenced Dec 2013.
• Data collection describing processes and outcomes
• Compared to standards of care
• 4 annual reports 2015, 2016, 2017, 2018
• 4th report published 8th Nov 2018 (2016-17 data)

4. Number of standards being met
0
5
10
15
20
25
30
35
40
45
50
0 1 2 3 4 5 6 7 8
Year 1
Number of standards met
NumberofhospitalsratedGreen

5. Number of standards being met
0
5
10
15
20
25
30
35
40
45
50
0 1 2 3 4 5 6 7 8
Year 1
Year 2
Number of standards met
NumberofhospitalsratedGreen

6. Number of standards being met
0
5
10
15
20
25
30
35
40
45
50
0 1 2 3 4 5 6 7 8
Year 1
Year 2
Year 3
Number of standards met
NumberofhospitalsratedGreen

7. NELA 4th Report
(2016 data)

8. NELA 4th Report
(2017 data)

9. NELA 4th Report
(2017 data)
• Variation in care
• Mortality
– Dorset 2% (n=121)
– Ysbyty Gwynedd 4.8% (n=108)
– Leicester Infirmary 5.4% (n=321)
3rd Report 4th Report
National 10.6 9.5
Northwest 11.1 8.4
Gt Man 9.7 7.6

10. NELA Northwest Performance
CT Reported before Sx
Risk documented pre-op
Pre-op review by cons ICU if mort >10%
Assessment by DME if age >70

11. Introduction of new Best Practice Tariff
2019/21

12. Introduction of new Best Practice Tariff
2019/21
For high risk EL patients (mortality >5%?)
>80% of eligible patients (NELA data) must receive BOTH:
• Consultant Surgeon and Anaesthetist presence in theatre
for high risk cases
– NW data: 11/25 Trusts with <85% of cases (amber/red rated)
• Critical care admission from theatre for high risk cases
– NW Data: 11/25 Trusts with <85% of cases (amber/red rated)
15/25 Trusts are amber/red rated for one or other of
these metrics.

13. Time to do things differently?