EP403 - Departmental Engagement in NELA AUDIT and Royal College Standards of Risk Assessment

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Abstract Aims A review of Theatre cases to assess compliance with the ‘National Emergency Laparotomy Audit’ (NELA) and associated guidelines. This study aims to review and ensure eligible NELA patients are being recognised. Further objectives are to verify if NELA scores are calculated and documented by an ST3+ and, in addition, if frailty is assessed as per Royal College and NELA Standards. Methods Data was retrospectively collected. Using ‘Epic’ EPR, all theatres from 01/05/23 - 01/12/23 were filtered for Emergency Laparotomy. These cases were manually reviewed for eligibility in NELA. 101 eligible cases were investigated to assess: documentation of NELA / Ppossum, grade of documenting Doctor, and frailty assessments / referrals. Results 39.6% of the sample had a NELA Score documented. While even fewer at 24.8% had NELA score documented correctly by an ST3+. While 61.4% of cases had a Ppossum Score documented, only 32.7% had both NELA & Ppossum Documented. As per NELA and National Guidelines, only 38.6% of patients 65+ received appropriate assessments of frailty. Conclusion National Targets for the identification of NELA patients, risk assessments and frailty assessments when appropriate are not being met. Ultimately, this presents with increased risks to patients while also reducing the data set size from which national governing bodies can produce future improvements in surgical health care. Moreover, poor engagement with National Guidelines has negative implications for departmental funding. There is a large space for improvement through education and procedural change across multiple sites with subsequent follow up reaudit.