Frequently Asked Questions

These FAQs will hopefully answer many of the questions that you might have about NELA. If you have additional queries, please contact us.

Below you can download the latest Frequently Asked Questions. This document will be constantly updated during the Patient Audit process and will have the date of when it was last updated.

Please check here regularly for new updates.



General Audit FAQs

What is NELA?

NELA is the National Emergency Laparotomy Audit. It is a National Clinical Audit commissioned by the Health Quality Improvement Partnership (HQIP). NELA is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). NCAPOP is a closely linked set of centrally-funded national clinical audit projects that collect data on compliance with evidence based standards, and provide local trusts with benchmarked reports on the compliance and performance. They also measure and report patient outcomes. NELA will look at structure, process and outcome measures for the quality of care received by patients undergoing emergency laparotomy. NELA will compare against standards of care such as those detailed in recent NCEPOD reports, and the Department of Health/Royal College of Surgeons of England's "Higher Risk General Surgical Patient (2011)".

Who is running NELA?

The NELA is being run by the National Institute of Academic Anaesthesia's Health Services Research Centre on behalf of the Royal College of Anaesthetists. The Clinical Effectiveness Unit of the Royal College of Surgeons of England and the Intensive Care National Audit & Research Centre are our partners and will provide important methodological and technical input as well as general advice on running national audits.

How long will NELA continue for?

NELA is currently funded until December 2017 with the possibility of a further extension.

Who can take part in the audit?

The NELA will include all NHS hospitals in England and Wales that carry out emergency laparotomy. This will include any hospitals with acute admission, emergency departments, or specialist centre's which carry out emergency laparotomy as a complication of other types of surgery. Non-NHS hospitals and hospitals in Scotland, Northern Ireland, Republic of Ireland and Channel Islands will also be welcome to contribute to NELA, but funding arrangements will need clarification, as the current HQIP funding only extends to coverage of England and Wales.

Does my hospital have to participate?

The NHS standard contract requires that organisations providing NHS care must participate in all relevant NCAPOP audits and enquiries. NCAPOP audits and enquiries are those commissioned by HQIP. If providers do not participate in relevant NCAPOP audits they will be in breach of their contract with their commissioner, therefore any non-participation would need to be agreed with the commissioner and CQC as the regulator.
Further information is available on the HQIP website.

HQIP's popular guidance document outlining the statutory and mandatory requirements for providers of NHS care in England has also been updated. The latest update has been carried out to include the:

  • 2014/2015 NHS Standard Contract
  • Detailed requirements on Quality Reporting from Monitor and the ending of inspections under the Clinical Negligence Scheme for Trusts.

More information can be found at: http://www.hqip.org.uk/resources/hqip-statutory-and-mandatory-requirements-in-clinical-audit-guidance/

What does the audit involve?

The audit consists of an organisational audit which will take place during the first year (2013-2014) and a patient audit which will commence in Year 2 of the NELA (2014-2015). We aim to achieve individual patient data collection in all eligible NHS hospitals by the end of the first three years of NELA. Data collection will be prospective on all patients that fulfil the inclusion criteria. The aim of the audit is to generate data that drives Quality Improvement (QI). QI will be facilitating through dissemination of collected data as well as workshops and seminars to drive specific QI projects alongside data collection. Annual reports will be published that provide detailed accounts of individual hospital's outcomes.

What are the Key Dates?

  • July-Sep 2013: Complete organisational audit
  • Dec 2013: 1st year of data collection process for patient audit commences
  • May 2014: 1st Report published (Organisational Audit)
  • Dec 2014: 2nd year of data collection for patient audit commences
  • July 2015: 2nd Report Published (1st Patient Audit)
  • Dec 2015: 3rd year of data collection for patient audit commences
  • July 2016: 3rd Report Published (2nd Patient Audit)
  • Dec 2016: 4th year of data collection for patient audit commences

Which patients will be enrolled in the audit?

  • All patients over the age of 18 years, having a general surgical emergency laparotomy in all NHS hospitals in England and Wales are eligible for inclusion and will be enrolled on a prospective basis. There is the potential to include the Devolved Nations should their funding bodies choose.
  • The aim is to include all emergency gastrointestinal procedures on the stomach, large and small bowel, for conditions such as perforation, bleeding, abdominal abscess or obstruction, via open or laparoscopic approaches.
    Emergency laparotomies following elective surgical complications will also be included in the NELA.
  • Patients requiring vascular surgery, gynaecological surgery, surgery on the renal tract, and laparotomy following trauma will be excluded.

To see the exact full inclusion / exclusion criteria click below:

What information will you be collecting?

It will include information about the structure of the service (e.g. provision of emergency theatres, provision of out-of-hours radiology), process measures (e.g. seniority of clinical staff in theatre, admission direct to critical care), and outcome measures (e.g. 30-day mortality, length of hospital stay). We will also collect demographic data, and clinical information to allow us to risk-adjust outcomes.

How will you collect the data?

Data will be collected via an online data collection web tool so that patient data can be entered directly into the audit database.

Hospital codes for Emergency Laparotomy

At present, we do not have clearly defined codes for emergency laparotomy - this has always been one of the difficulties in auditing this area as there are potentially around 400 of them. The document below does give some indication which we hope will be useful. We are hoping to be able to issue some additional guidance at some point in the future.
 Emergency Laparotomy Article - Anaesthesia Journal 2012 - AAGBI.pdf (77 KB)

How will you feed back the results of the audit?

NELA is on the list of national audits for inclusion in Trusts' Quality Accounts. We will be issuing annual reports that will include key outcome data, identifiable at hospital level. These will be adjusted for risk. We will also provide comments on whether relevant standards are being met. A Public & Patient Guide will be made available to accompany the Annual reports.

Is my hospital involved?

You should contact your hospitals NELA Local Administrator if you would like to be involved in the NELA. If you are unsure if your trust or hospital is participating or need the name of the local administrator please contact us.

Who do I need to involve in my hospital?

Emergency laparotomy is a complex clinical pathway that includes input from surgeons, anaesthetists, intensivists, physicians, radiologists, nursing staff, and other allied medical professions. All of these specialities will need to be aware of the audit and many will need to participate directly. Even if you are not the local NELA coordinator, you can help by starting to discuss the audit within your hospital. Its success will depend on a coordinated effort by all involved. Your clinical audit department is also likely to be able to help. We will also be writing to every Chief Executive and Medical Director to inform them of the audit, and the need for every hospital to participate.

What is the role of the Emergency Laparotomy Network?

We will work closely with the established Emergency Laparotomy Network (ELN). In many cases, ELN members will be the first point of contact, and many have already asked to be the local NELA coordinator. More information about the ELN can be found at: www.networks.nhs.uk/laparotomy.