Proposal for ROCR Approval
1. Record
Type?
New
2. Unique
Number
R01036
3. Title
National Emergency Laparotomy Audit
4. Collection
Type
National
5. Other
Reference
6. Description
The National Emergency Laparotomy Audit (NELA) is
part of the National Clinical Audit and Patient
Outcomes Programme (NCAPOP), overseen by the
Healthcare Quality Improvement Partnership (HQIP).
NCAPOP is a closely linked set of centrally-funded
national clinical audit projects that collect data on
compliance with evidence based standards, and
provide local trusts with benchmarked reports on the
compliance and performance. They also measure and
report patient outcomes. NELA was commissioned
following evidence of a high incidence of death, and a
wide variation in the provision of care and mortality,
for patients undergoing emergency laparotomy in
hospitals across England, Wales and Scotland. The aim
of the audit is to enable the improvement of the
quality of care for patients undergoing emergency
laparotomy through the provision of high quality
comparative data from all providers of emergency
laparotomy. The contract for the provision of the NELA
was awarded to the Royal College of Anaesthetists
(RCoA) in June 2012. The Clinical Effectiveness Unit of
the Royal College of Surgeons of England and the
Intensive Care National Audit & Research Centre are
partners and provide important methodological and
technical input. The NELA is currently funded for 3
years with the potential of a further 2 year extension.
Proposal for ROCR Approval
The contract commenced in December 2012 with an
organisational audit performed in year 1. Individual
patient data collection commenced in Year 2 and 3
(Dec 2013-Nov 2015), with the potential for funding to
be extended until 2017. All patients aged 18 and over,
having a general surgical emergency laparotomy in all
NHS hospitals in England and Wales will be enrolled on
a prospective basis. NELA will look at structure,
process and risk-adjusted outcome measures for the
quality of care received by patients undergoing
emergency laparotomy. NELA will compare against
standards of care such as those detailed in recent
NCEPOD reports, and the Department of Health/Royal
College of Surgeons of England’s “Higher Risk General
Surgical Patient (2011)” The aim of the audit is to
generate data that drives Quality Improvement (QI).
QI will be facilitated through dissemination of collected
data as well as workshops and seminars to drive
specific QI projects alongside data collection. NELA
data will be linked to other sources of routine data
including Critical Care Data (Intensive Care National
Audit and Research Centre (ICNARC) case mix
programme), Bowel Cancer Data (National Bowel
Cancer Audit/Upper Gastro-intestinal Cancer Audit)
and Hospital Episode Statistics (mortality data). NELA
will be delivered by a central project team from the
National Institute of Academic Anaesthesia’s Health
Services Research Centre based at the RCoA. Formal
oversight will be provided by a Project Board
consisting of key stakeholders. Scientific input will be
provided by a Clinical Reference Group consisting of
representatives from all relevant clinical professional
and specialty stakeholders (including patient groups).
7. State
Submitted to ROCR
8. ROCR
Reference No
SCCI2057
9. Start Date
01/12/2013
Proposal for ROCR Approval
10. End Date
30/11/2015
11. FT
Collection
Type
MANDATORY
12. Collection
Type
MANDATORY
13. Owning
Organisation
Royal College of Anaesthetists
14. Owning
Department
Research
15. Owner
Name and
Contact
Details
Name: Jose Lourtie
Email: jlourtie@rcoa.ac.uk
Tel No: 020 7092 1683
Location: London
16. Senior
Supporting
Official Name
Dr Dave Murray
17. Senior
Supporting
Official
Contact
Details
Title: Dr
Tel No: 01642 854600
Email: dave.murray@stees.nhs.uk
Location: James Cook University Hospital,
Middlesbrough
18. Data
Provider Burden Days
1502.67
Proposal for ROCR Approval
18. Data
Provider Burden £
£ 668106.51
18. Frequency
Ad-Hoc
18. Source
Organisations
(Number of
orgs)
Acute Foundation Trust (88) , Acute Non Foundation
Trust (59)
19. Set Up
Costs
£0
20. Other
Costs
£ 1039031
21. Total
Costs
£ 1707137.51
22. Please
explain the
reason for any
increase or
decrease in
burden and
provide
details of the
any other
costs figure
provided in
Q20
n/a
23. Benefits to
Patients and
the NHS
Benefits include: - To enable secondary care providers
to improve the delivery of care to patients undergoing
emergency laparotomy using information produced by
the audit. - To provide comparative information on the
organisation of care by providers of Emergency
Laparotomy. - To provide comparative information on
Proposal for ROCR Approval
patient outcomes following surgery for Emergency
Laparotomy. - To facilitate the development of
effective change (quality improvement) initiatives and
thereby spread examples of best practice and help
local providers make the best possible use of audit
results. - To explore the potential for Patient Reported
Outcome Measures to be included in the Programme if
and when appropriate tools / collections become
available. Mortality from emergency laparotomy has
remained high for many years and emergency surgery
has been an underfunded and under resourced
specialty. National data of high quality will support the
argument for investment and allow us to track high
and low performing centres in order to learn from the
former and help support the latter. With morbidity and
mortality so high, even small amounts of improvement
will save a significant numbers of lives.
24. Financial
benefits to
running this
collection
The annual cost of emergency laparotomy care has
been estimated at ~£650 million. (Shapter
Anaesthesia 2012, 67, 474–478), of which ~75%
represents ward/critical care costs. Improvement in
care would be expected to reduce this. Even a 1 day
reduction in length of stay would be expected to save
~£20 million.
25.
Publication
methods
NELA is on the list of national audits for inclusion in
Trusts' Quality Accounts. NELA will issue annual
reports that will include key outcome data, at named
hospital level. NELA will also provide comments on
whether relevant standards are being met. A Public &
Patient guide will be made available to accompany the
Annual reports. There will be the capability for
Hospitals to access their own data through an online
web tool. This data can be exported at any time by the
local NELA leads and be used to quality improve
service.
26.
Publication
http://nela.org.uk/NELA_home
Proposal for ROCR Approval
Links
27.
Requesting
Organisation
Royal College of Anaesthetists
28. Collection
Method
Web based collection
29. NHS
Mandate
Commitment
-Helping people to recover from episodes of ill health
or following injury -Preventing people from dying
prematurely -Ensuring that people have a positive
experience of care -Treating and caring for people in a
safe environment and protecting them from harm
30. Changes
since last
assessment
31. Data in
operational
systems
Yes
32. Plans for
collecting this
data from
operational
systems
33. If the data
was not
collected,
what would
the
consequences
be
This audit forms part of the HQIP NCAPOP audit
programme. Hospitals would be unable to participate
in a mandated NHS audit The NHS standard contract
requires that organisations providing NHS care must
participate in all relevant NCAPOP audits and
enquiries. NCAPOP audits and enquiries are those
commissioned by HQIP. If providers do not participate
in relevant NCAPOP audits they will be in breach of
their contract with their commissioner, therefore any
non-participation would need to be agreed with the
Proposal for ROCR Approval
commissioner and CQC as the regulator. NELA data
will be linked to other sources of routine data including
Critical Care Data (Intensive Care National Audit and
Research Centre (ICNARC) case mix programme),
Bowel Cancer Data (National Bowel Cancer
Audit/Upper Gastro-intestinal Cancer Audit) and
Hospital Episode Statistics (mortality data).
34. Is there an
impact
assessment or
business case
for this
collection? If
so please
attach
No
35. Process
required for
others to go
through to
obtain the
data
The aim of the audit is to generate comparative
information that drives Quality Improvement (QI). QI
will be facilitated through dissemination of collected
data as well as workshops and seminars to drive
specific QI projects alongside data collection.
Individual hospitals participating in the audit have
access through the online web tool to their own data
when required. They are able to export a full list of
their completed patient cases and so they may use
their audit data to support local quality improvement
initiatives. There is also a process by which others can
link to the NELA data collected. This would be by going
through the HQIP data sharing agreement process.
36. Keywords
emergency laparotomy
37. National /
Official
statistic
NA
38. Method
used to store
the data
How will data be protected? The server is hosted by
UKFast in a secure datacentre. All traffic passes
through Cisco equipment including Anomaly Detection
Proposal for ROCR Approval
Systems (ADS), Intrusion Detection Systems (IDS)
and Intrusion Prevention Systems (IPS). This is
clustered across multiple locations. The hardware is
protected by a Cisco Firewall with full access controls
enabled. UKFast carry out annual security audits as
standard within the terms of the contract. These
audits will inspect the system for any vulnerabilities or
threats that could allow hackers to destroy or damage
the system. Each UKFast datacentre is fully powered,
secure, resilient and equipped to meet the project
demands. The company has a track record in
delivering to many private and public sector clients
including the NHS and has demonstrated a strong
awareness of the need to protect systems and data
from both physical and virtual threats. UKFast has
attained ISO-27001:2005 certification for their
Information Security Management System and ISO
9001:2008 for their Quality Management System.
They are PCI compliant for all client transactions. 1.
System Security - Full Security patching; - Dedicated
firewall; - Risk assessment and security consultation
and auditing; - Programmed evaluation and testing of
all systems; 2. Physical and site security - Unassuming
facilities, unmarked and inauspicious; - On site
security 24/7/365; - Electronic surveillance with
continual monitoring/recording; - Electronic access; Client access by appointment only; - Dual power
supply, UPS and onsite generator backup; - Fire,
power, weather, temperature and humidity monitoring
systems; - Diverse fibre routing via multiple carriers; Cross connection to a number of tier 1 carriers; - 24
hour security patrol (NSI accredited security).
39. Why
sampling is
not used
The agreed contract with HQIP is to collect data from
all providers of care as this was identified as the most
appropriate method of bringing about the required
Quality Improvements
40. Details of
any pilots
Both the organisational audit and patient audit
underwent extensive pilot testing. Using local hospital
Proposal for ROCR Approval
participants to feedback on audit data collection
process, questions and All relevant clinical professional
and speciality stakeholders will have direct input into
the design and conduct of this audit. This will be
achieved through the Clinical Reference Group that
consists of representatives from partner organisations
as well as other stakeholders including patients. The
CRG will act in an advisory capacity to the Project
Team, providing specialty specific advice, and lay
advice as appropriate. The CRG will review the audit
design regularly and will also review drafts of any
reports and recommendations issued.
41. Equalities
dimensions
used in the
collection
Age/Date of Birth, Gender
42. Policy that
the collection
supports
N/A
43. IG Data
type
Patient identifiable