EP.FRI.454 National Emergency Laparotomy Audit: are we compliant with pre-operative mortality risk documentation?

Abstract

Abstract The National Emergency Laparotomy Audit (NELA) set out key performance indicators in patients undergoing emergency laparotomy, one of which is the assessment of individuals pre-operative risk of mortality. This should be made explicit to the patient and recorded clearly on the consent form and in the medical record.1 Pre-operative mortality risk can be calculated through clinical assessment or using the NELA risk scoring tool. Omission of a this can lead to patients missing out on accepted standards of care and belies gaining informed consent. A snapshot audit of patients added to the NELA database was performed between 01/08/2020 and 31/10/2020. Data collected included the pre-operative mortality risk percentage (if calculated) and whether the patient was taken to theatre. This figure was correlated against the patient's physical notes or scanned copies on Medway. A target level of ≥ 85% of patients having their pre-operative mortality risk calculated and the this figure being documented appropriately. 49 patients were uploaded to the NELA database and 80% (n = 39) had a calculated risk. 55% of these patients (n = 27) proceeded to theatre, however correlation with physical notes and scanned documents on Medway revealed none had the correct documentation as per NELA standards. A questionnaire circulated to trainees and consultants exploring their understanding of pre-operative mortality risk documentation. Of the 7 respondents, 4 stated they rarely or never documented the pre-operative mortality risk as per NELA guidance. Ideas for improving the documentation process included a NELA pathway document, visual aids (e.g. poster) and a pre-operative mortality risk sticker.