The National Emergency Laparotomy Audit (NELA) has published its tenth patient report, which examines care received by patients admitted for emergency bowel surgery in England and Wales between 1 April 2023 and 23 April 2024.
The fall in median length of stay of one day could represent potential annual financial savings of more than £10million
It found that 30-day mortality fell to the lowest level in ten years of audit, and postoperative length of hospital stay fell back to a median of 10 days (compared to 11 days in Year 9). This reduction in mortality represents around 1,150 fewer deaths per year amongst the estimated 32,000 patients who undergo emergency laparotomy.
There was evidence of wide variation between hospitals in both processes and outcomes of care: more remains to be done to reduce disparity and ensure all patients benefit from the highest standards of care. As well as key messages relating to themes including timeliness of care, communications and critical care bed capacity, this report contains suggestions for quality improvement (QI) and key recommendations:
- Relevant Royal Colleges should:
- continue to work together to update and develop consensus pathways of care for patients who might require emergency abdominal surgery
- highlight current guidelines around the need for effective two-way direct communication between referrer and reporter whenever the patient’s condition or CT predicted findings suggest the patient has developed time-critical pathology
- work together across the blended workforce to develop common competency-based training and education around optimising perioperative care for older patients and those living with frailty
- NHS England, Integrated Care Boards, and Welsh Health Boards should evaluate variations in critical care bed capacity for patients undergoing emergency laparotomy.
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