Patient Information

An emergency laparotomy is a major operation where the surgeon has to cut open the abdomen (stomach area). It is called "emergency" because it must be done very soon or even immediately and cannot wait until a later date. It might be carried out for several reasons including internal bleeding, perforation (a hole or tear), obstruction (a blockage) or infection. For many patients, an emergency laparotomy is the only treatment which could help them get better.

NELA stands for National Emergency Laparotomy Audit. The English and Welsh governments ask for NELA to be delivered each year, with oversight from the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme. Clinical audits take place by independent organisations to assess the quality of care in hospitals by looking at how hospitals treat patients and the outcomes of those patients. NELA is a national clinical audit, which means it is being carried out in around 180 hospitals in England and Wales. NELA looks at the quality of care received by patients undergoing emergency laparotomy.

NELA started in 2012 and since then a number of improvements have been made to the care received by patients having an emergency laparotomy, for example:

• Deaths within 30 days of surgery have fallen from 11.8% of emergency laparotomies in the first year of the audit to 8.7% in the last report.
  
• Average stay in hospital after emergency laparotomy has decreased from 19.2 days in the first year of the audit to 15.1 days in the last report.
  
• Patients now overwhelmingly received care delivered by consultants.

We want to improve the care that patients undergoing emergency surgery receive. To do this we will collect important information on how well your hospital is providing care for you. We will then give hospitals all the valuable information we have obtained. This will highlight areas of their service where they are doing well, and areas in which they can improve. It will also allow hospitals to compare themselves with others all around the country. All hospitals in England and Wales that carry out emergency laparotomy are expected to participate in this audit.

The audit collects information about the care patients receive while having emergency bowel surgery. This includes things like the time of day you had surgery, how long you may have waited for surgery, what the surgeon found during surgery, and what sort of ward you went to after your surgery. The audit also collects confidential information that includes your name, NHS number, date of birth, gender and postcode. The audit will not publish any information that could enable individual patients to be identified.

All this information is collected so that we can compare and link our data with other national databases to capture as much information as possible, including death rates. The more data we have the easier it will be for us to understand where care needs to be improved.

The information that NELA collects is treated as confidential and is kept securely at all times. None of the reports that the audit produces contain information that could identify a patient.

The information is only available to the audit team in a 'pseudonymised' way, which means that patients can only be identified through a computer-generated sequence of numbers. Patient names and other similar personal information is only available to the Data Protection Controller for the audit and only used for linking to other national databases as noted above.

To prevent unauthorized access or disclosure of patient data, we have numerous physical, electronic, and managerial procedures to safeguard the information we collect.

Occasionally, NELA is asked to support medical research to improve surgical care. Researchers must apply to access NELA data and they must ensure that appropriate safeguards are in place to protect the data. NELA will never share your personal confidential information like name, NHS number, or date of birth, with other researchers.

Because some patients are very sick before and after they have an emergency laparotomy, it would be very hard to ask all patients for their consent to use their data. It is important that we get information from all patients, not just those that are well enough to give consent. That's how we can provide an accurate overview of quality.

As an additional safeguard for your information, NELA activities are reviewed by the Confidentiality Advisory Group, or CAG, an independent organisation who help protect the interests of patients in health and social care research and audits.

In 2018, the NHS decided that people should have the right to 'opt out' of having their data included in such audits. However, the National Emergency Laparotomy Audit is exempt from this - losing even a small number of cases could provide the wrong picture about a hospital's performance. The national data opt-out is broad legislation that allows you to remove consent from having your data used for a variety of planning and research purposes. You can find out more here:

If you have a specific objection to having your data included in NELA, you can still withdraw your information from NELA. Send an email to NELA@rcoa.ac.uk and put 'patient request to opt-out' in the subject line or call the NELA team at 0207 092 1580. We will then contact your hospital to request that they do not enter your details into the audit. If your data has already been collected, we may be able to delete it if it has not already been used for audit analyses.

If you had surgery between March 2014 and October 2015 in a participating hospital, your non-personal data may be shared with a study team at Queen Mary University London for the purposes of research. This data will be combined with information from the Office for National Statistics and Hospital Episode Statistics in order to investigate long term outcomes. The study is called EPOCH, please visit their website for more information: