National Emergency Laparotomy Audit (NELA)

National Clinical Audit

Delivered by:

Royal College of Anaesthetists (RCoA)

Website:

The aim of this programme is to improve the quality of care for patients undergoing emergency laparotomy in England, Wales and Northern Ireland, through the provision of high-quality comparative data from all providers of this procedure. It also covers patients who meet the criteria for an emergency laparotomy, but who do not undergo surgery – their inclusion provides valuable insights into variations in clinical care and outcomes for high-risk patients managed without surgery.

The National Emergency Laparotomy Audit has transformed the way we deliver emergency surgical care. By providing robust, transparent data and benchmarking outcomes nationally, it has empowered teams to identify variation, drive quality improvement and ultimately save lives.” Lyndsay Pearce, NELA Chair

Supporting improvement

NELA publishes healthcare quality improvement plans, outlining improvement goals, for both operative and non-operative cohorts. They also provide resources and reports to local teams throughout the audit year, to help them visualise performance across audit metrics. The intention is that local teams will review these, understand the metrics, identify where improvements can be made, and action this improvement.

In addition, NELA provides a series of webinars through the year with a QI focus, to help teams stimulate local improvement, and hosts QI-themed poster prizes at national conferences, encouraging local teams to use NELA data for local QI and present their ideas to the wider community. For more information, visit NELA’s website.

Additional data and resources

In addition to HQIP-published reports below, NELA analyses local site compliance with their metrics on a regular basis, and publishes these reports in the public domain. These are available at hospital and either Integrated Care Board level (in England), or national level for Wales and Northern Ireland. They also publish graphs of trends in key metrics over time, and local teams can export their own data if they would like to review specific questions. For more information, visit NELA’s website.

Since its inception, NELA has worked in partnership with the healthcare community to achieve a significant improvement on clinical care and patient outcomes. Since 2012, mortality rates have fallen from 11.7% to 8.1% and the average length of hospital stay dropped from 18.1 days to 16.2 days (2023/2024). Many best-practice components are now embedded in routine care, like performing pre-operative risk assessments and direct consultant involvement in the care of high-risk patients. NELA data has also contributed to nearly 90 peer-reviewed publications.