National Emergency Laparotomy Audit

The National Emergency Laparotomy Audit (NELA) will be for NHS-funded care in England, Wales, Northern Ireland and Jersey (inclusion of other devolved nations/Crown dependencies is yet to be determined and will be detailed within the tender documentation).

The initial contract is anticipated to be for a period of 3 years, at a maximum total budget of up to £ 951,168.00 excl VAT and £1,141,401.00 with VAT. Bids exceeding this limit will be rejected. Due to the unknowns in advance of holding the premarket engagement session, it is currently expected that the extension value will be a 2-year pro rata of the core 3-year funding, estimated at £634,112.00 excluding VAT.

There is potential to include other Devolved Nations and/or Crown Dependencies, and aspirational measures (which will be defined in the service specification).

The role of a national clinical audit is to stimulate healthcare improvement through the provision of timely and high-quality information on the organisation, delivery and outcomes of healthcare, together with tools and support to enable healthcare providers and other audiences to make best use of this information. Outcomes are benchmarked against national guidance and standards e.g. quality standards from the National Institute for Health and Care Excellence (NICE), and those from other established professional and patient sources. Successful national audits are those where the individuals providing the data can also improve the system, and there is a shared understanding of what good care looks like.

The National Emergency Laparotomy Audit (NELA) was established in 2011 and has been delivered by the Royal College of Anaesthetists (RCoA) - www.nela.org.uk ↗

The overarching aim of this audit is to stimulate improvements in care for patients undergoing and not undergoing emergency laparotomy through the provision of high-quality comparative data from all providers of emergency laparotomy by measuring and reporting variations in quality of care and patient outcomes. During this contract period, the successful tenderer will need to build on the achievements of the audit to date and enhance the ability for the audit to be used for healthcare improvement by engaging with clinicians, patients and commissioners (both local and national) and regional networks.

Successful national audits are those where the individuals providing the data are also in a position to improve the system, and where there is a shared understanding of what good care looks like. Data is most useful locally for healthcare improvement when its provision to clinical teams is timely, the data is refreshed regularly, and appropriate tools, support and guidance accompany the data outputs. The intent is for all of these features to be implemented and improved during the period of this future contract.

Develop a robust, high-quality audit designed around key quality metrics likely to best support local and national quality improvement

Detect, describe and help reduce unwarranted clinical variation by systematically benchmarking performance, identifying outliers, and supporting services to understand variation in outcomes, processes and experience

Achieve, articulate and maintain close alignment with relevant NICE national guidance and quality standards throughout the audit, as appropriate

Enable healthcare quality improvements through the provision of timely, high-quality data that compares providers of healthcare, and comprises an integrated mixture of named Trust or Health Board, Integrated Care System (ICS), multi-disciplinary team, possibly consultant or clinical team level and other levels of reporting

Engage patients, carers and the public in a meaningful way, achieving a strong patient voice which informs and contributes to the design, functioning, outputs and direction of the audit

Consider the value and feasibility of linking data at an individual patient level to other relevant national datasets either from the outset or in the future, and plan for these linkages from the inception of the contract

Ensure robust methodological and statistical input at all stages of the audit

Identify from the outset the full range of audiences for the reports and other audit outputs, and plan and tailor them accordingly.

By way of example, the current contract specification includes the following anticipated benefits of the National Emergency Laparotomy Audit:

National benchmarking to highlight unwarranted variation between providers

Sustained reduction in 30-day mortality and postoperative complications through systematic performance monitoring against national standards

Reduced length of hospital stay, supporting faster recovery and improved patient flow

Increased delivery of time-critical interventions (e.g. antibiotics for sepsis, timely access to theatre), improving survival and outcomes

Enhanced care for high-risk and frail patients, including improved peri-operative specialist input

Shift from retrospective reporting to near real-time data and interactive dashboards

Improved insight for regulators, commissioners and systems (ICSs) through consistent performance data

Systematic identification and management of outliers and ‘cause for concern’, enabling early intervention

Standardised performance metrics aligned with NICE and other national guidance

Provide audit results in a timely, accessible and meaningful manner to support healthcare quality improvement, minimising the reporting delay and providing continual access to each unit for their own data

Utilise strong and effective project and programme management to deliver audit outputs on time and within budget

Develop and maintain strong engagement with local clinicians, networks, commissioners, patients and their families and carers and charity and community support groups to drive improvements in services

Embedded healthcare improvement plans with measurable objectives and ongoing impact evaluation

Support for coordinated improvement across the entire emergency laparotomy pathway

Increased use of routine data and data linkage to reduce manual data collection burden

Improved data completeness, quality and efficiency, supporting robust analysis and decision-making

Systematic assessment of inequalities in access, care and outcomes

Support for national and local priorities to reduce inequalities and promote parity of care

Active involvement of patients, carers and the public in audit design, outputs and improvement priorities

Flexibility to expand scope (e.g. non-operative pathways, wider geographies including devolved nations and Crown Dependencies)

Designed to evolve with emerging evidence and service models

Further details of the existing audit can be found at: www.nela.org.uk ↗