161 Trends in outcome after emergency laparotomy - a ten year experience

Abstract Introduction The NELA study started in 2012 and has produced several national reports which describe hospital-level outcomes after emergency laparotomy. Our DGH has identified local trends in performance over the past decade Methods Each national NELA report was interrogated. Performance of our hospital in each process measure was compared between years. Contributing factors to trends in performance were explored. Results There have been 1554 cases. The number of laparotomies performed has increased from 142 in Year 1 to 231 in Year 9. Case ascertainment has steadily improved from 90% to 100%, most markedly since the creation of a NELA fellow post. Process measures where the unit has consistently fallen below the national average include patients going to ICU after emergency surgery (40% vs. 86%). Patients receive timely surgery considerably more often than the national average (88.9% vs. 67.1%). In Year 7, a pilot project to employ an elderly care physician led to over 60% of appropriate patients receiving medical review, though this was not continued and fewer than 20% of patients usually receive such a review . Average mortality was 5.6% and the unit has always been in the lowest quartile for mortality. Conclusions Wide review of an individual hospital's performance can aid decision-making at an Executive level to improve the service and decide where to allocate resource. These data have been used to create Business Cases for a permanent surgical elderly care physician and to advocate for a 'change in culture' amongst intensivists in accepting patients to the ICU.