If appropriate resources are not available, the level of clinical activity should be adjusted to ensure a safe provision of care while maintaining quality, education and training and wellbeing.
Author: Dr Dave Murray, Consultant Anaesthetist South Tees NHS Trust; Chair NELA
The National Emergency Laparotomy Audit (NELA) is 10 years old this year, so this is a timely point to review progress, highlight achievements, and look at the persisting challenges ahead.
NELA was commissioned in 2012. One of the key pieces of evidence to support its funding was the paper published by the Emergency Laparotomy Network.1 This observational study of more than 1,800 patients highlighted a 15% mortality rate, but with a nine-fold variation in mortality across the 35 trusts. Consultant presence was 74% for surgeons and anaesthetist presence was 64%. Half the patients were admitted to critical care, and patients returning to the ward had a 6.7% mortality rate.
Opioid doses should be adjusted accordingly to take into consideration a patient’s medical history and any comorbidities.37
Patients should be provided with information specific to their condition/indication for surgery in addition to information about day surgery. Clear and concise information given to patients at the right time and in the correct format is essential to facilitate good day surgery practice.5 This information should be provided before the day of surgery and may be given to patients...
