Clinical audit
Reducing mortality in emergency laparotomy
Jose Lourtie, head of research for the Royal College of Anaesthetists, explains how the National Emergency Laparotomy Audit is helping hospitals to reduce deaths and deliver better patient outcomes. Supported by the team behind CaseCapture, insights are helping to prove resourcing needs and drive crucial quality improvement.
Concerns around high mortality rates for emergency laparotomy surgery led to the creation of a new clinical audit spanning England and Wales in 2012 – the aim: to allow NHS hospitals to better understand and take action to address widespread variation in care. A decade later and significant impact has been realised for the safety of tens of thousands of patients who undergo emergency bowel surgery each year. Improvements in care provision have been informed by the National Emergency Laparotomy Audit, or NELA, managed by the Royal College of Anaesthetists on behalf of the Healthcare Quality Improvement Partnership (HQIP). “Mortality has reduced from nearly 12% to
around 9%,” says Jose Lourtie, head of research for the Royal College. “That is a big reduction in mortality.”
The annual audit, built using bespoke
web-tools created by the team behind the CaseCapture clinical audit system, has led to a range of improvements throughout its history, including reduced variation in care, reduced lengths of stay, and improved patient comfort and experience. It has also resulted in substantial cost
savings. Back in 2018, the Royal College recorded that 108,000 bed days had been saved, equating to £34 million in savings. “Just the audit existing has focused minds,”
says Lourtie. “We are much safer than we were when we first started the audit, despite the challenges and pressures faced in hospitals today.”
Evidence for resource The latest annual report, published in February
2023, shows that emergency laparotomy is still a significant surgical focus in the NHS, with data captured on more than 22,000 procedures in a single year. Despite significant progress in care standards since measurement began, the latest report also reveals that falling mortality has plateaued in recent years. “That needs to be taken in context with
everything else going on, including COVID-19,” says Lourtie.
He adds that the audit provides the evidence
clinicians now need to take improvements to the next level: “Now, our findings show that we are reaching a point where more resource is required for further reduction in mortality,” he says. “Individual sites can utilise that intelligence. They can take it to their medical directors and say ‘we need more resource in our area, because we are no longer showing improvement’.” Such data is also seen by decision makers at a national level: “The report is signed off by NHS England – so they are aware of what the figures are showing,” explains Lourtie. “They can see what needs to be improved nationally.”
A local quality improvement tool The audit is about more than highlighting national trends. Regional and local variation, highlighted in the audit, continues to allow individual hospitals to improve. Data from 173 hospitals was included in the latest national report. Those hospitals are able interrogate live data, as it is captured. “Trusts value seeing their data live,” explains Lourtie. “The tools we use mean that you can compare yourself to hospitals that are like yours, or to the national picture. The visualisation of the data and what you can pull out has been incredibly useful, and it has become simple to click on the tool to visualise where you sit.”
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www.clinicalservicesjournal.com I July 2023
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