Third Patient NELA Audit Report published

Improvements in the care of patients before, during and after emergency bowel surgeries have reduced patients’ average hospital stay from 19.2 days in 2013 to 16.6 days in 2016, saving the NHS an estimated £30 million annually.

According to a joint national report published today, led by the Royal College of Anaesthetists (RCoA), enhanced patient care has also led to the national 30-day mortality rate falling from 11.8 per cent to 10.6 per cent over three years, representing approximately 300 patients lives saved each year compared to 2013-2014.

Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the third annual National Emergency Laparotomy Audit (NELA) report analyses the care received by close to 25,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2015 and November 2016. More than 600 local clinical leads working together with nursing colleagues and other collaborators have contributed to data collection for the audit, and brought about these improvements.

There have been improvements in key areas of patient care to achieve these successes, however some hospitals fall short of the standards referenced within the NELA report. Examples of areas where more improvement is still needed include:

  • 24 per cent of hospitals miss the target of getting the most urgent  patients to the operating theatre within the expected two hour timeframe
  • 22 per cent of hospitals are not meeting the accepted standard of admitting high risk patients directly to critical care after surgery
  • Almost half of all patients were aged over 70, yet only three per cent of hospitals provide regular pro-active assessments from geriatricians for elderly patients after their surgery

Data from the audit also finds that significant variation exists between hospitals and even within the same hospital in the provision of patient care. The ‘time of day’ effect also remains an issue, with patients undergoing the procedure during the day consistently receiving better care than those undergoing the procedure at night.

The number of hospitals achieving positive ratings for meeting key standards of care has improved since the beginning of the audit. Over the last three years, improvements have been made in important areas of patient care such as ensuring a consultant anaesthetist is present in the operating theatre for high risk patients, and conducting risk assessments for every patient. There has been an increase in the number of high risk patients being transferred to critical care immediately after surgery, although further improvement is still required in this area.

Dr Liam Brennan, President of the Royal College of Anaesthetists, said: “This report highlights how sustained improvement in patient care can reduce the strain on NHS resources. Patients are now being discharged home an average of two-and-a-half days sooner as a result of better care and hospitals are saving money as a result.

“With winter approaching we know that finding a bed for a patient can be a challenge in many NHS hospitals. Delivering high quality care and ensuring patients return home sooner is an important first step in alleviating this pressure.”

Dr Sarah Hare, NELA National Clinical Lead, said: “Improvements have been made, however we must acknowledge patients should expect to receive the same level of high quality care, regardless of when and where their surgery takes place. Although we have made great strides since NELA reporting began in 2013, the inconsistency of care remains an issue we are determined to address. This report highlights the continued importance for clinicians, hospital managers and commissioners to work together to reduce variation in patient outcomes and overall standards of care.”

Mr Iain Anderson, NELA Surgical Advisor and vice-president of the Association of Surgeons of Great Britain and Ireland, said: “Surgical teams have worked very hard to achieve these improvements and the availability of individual hospital performance indicator reports is now helping hospitals to analyse and identify areas where further improvement is needed in order to provide the best possible care to patients. However, we do need to address the lack of time being made available to clinicians outside of their clinical duties which is needed to drive forward the changes in care.”

Professor Keith Willett, NHS England Director for Acute Care, said: “More people are surviving bowel surgery, thanks to improved and faster NHS care. This is good news for patients and for other taxpayers with more beds freed up for those who need them, saving around £30 million each year. Of course there is more progress to be made particularly around reducing variation and this report will help us to understand what we need to do next to improve treatment."
Donna Armitage Taylor, emergency laparotomy patient, said: “As a patient, when you are in the position of needing this kind of high risk emergency surgery you, and your family, depend on multidisicplinary teams to work closely and effectively together to ensure that you are cared for in the best possible manner
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So, what do audits mean for patients? The truth is, very little, unless they translate into improved care for us and are presented in a way that we can use them to understand the care that we should receive. The team who cared for me had been working together using the NELA data, sharing it in innovative ways, and acting upon it to improve the care I and other patients received.”

13 October 2017

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