Title : Championing change: Enhancing NELA case ascertainment through team ownership
Abstract:
Background: The National Emergency Laparotomy Audit (NELA) is a UK-wide quality improvement initiative, established in 2012, aimed at reducing morbidity and mortality for patients undergoing emergency laparotomy through comparison against national standards and feedback. Complete case documentation is essential to ensure accurate audit data, drive quality improvement, and meet national standards. The most recent NELA report recorded a national case ascertainment rate of 72.1%, below the target of 100%.
Aim: To assess and improve compliance with NELA documentation for all eligible emergency laparotomy cases in our emergency general surgery department
Methods: All emergency laparotomies performed were identified from a prospectively maintained departmental database. Each case was categorized as complete (fully submitted NELA record), incomplete (partially entered) or not started (no entry). The audit standard was 100% eligible case submission. Baseline data were collected in July 2024. Interventions included appointing NELA “champions” responsible for monitoring monthly compliance and sending reminders to clinicians, delivering targeted educational sessions, and disseminating informative posters. Compliance was re-audited in October and November 2024.
Results: An average of 11 emergency laparotomies were performed per month. At baseline (July), 11% of NELA records were complete, 11% incomplete and 78% not started. Post-intervention, complete records rose to 50% in October and 80% in November. Records not started decreased to 30% in October and 10% in November. This represents a 69-percentage point increase in complete records post-intervention.
Conclusion: Targeted team-based interventions, including local ownership and continuous education, resulted in a substantial and sustained improvement in NELA case ascertainment. These measures enhanced quality of national audit data, potentially driving improved patient outcomes. The approach is low-cost, adaptable to other surgical departments nationally, and effectively engages junior surgical teams in national audit efforts.
