emergency laparotomy collaborative...replace p-possum scoring with nela risk score in booking...

Emergency Laparotomy Collaborative

13th March 2019

Russells Hall Hospital Case ascertainment and locking

Dr Jenny Wright

SOARTM

Strengths Within our trust

Strong anaesthetic leadership NELA

Job planned time

Named anaesthetic NELA trainee lead

Named surgical lead (job planned)

Senior management (clinical and General Mx) engagement and support for NELA/EmLap

Regular reporting at governance meetings

Admin support and successful business case for elderly care

Strengths Awareness High awareness in Trust of NELA/EmLap

NELA included in trainee induction surgeons and anaesthetists

Log-ins for all

Risk scoring at electronic booking (P-POSSUM)

Regular emails – follow up missing/incomplete cases – NELA ‘Naughty Step’

Newsletter - quarterly

Audit presentations – use of data encourages better input

Newsletter

Newsletter

NELA Star Award

Strengths Data capture EmLap/NELA section on WHO form

Surveillance of data input for accuracy & feedback

Data input – trainees shown method in theatre

EPR used for time of arrival ED/hospital/ward stays

Theatre database – used for time of booking, anaes room entry, returns to theatre

Elderly care email + completion of NELA

WHO Checklist EmLap Section

Use PAS and EPR to source info

Use PAS and EPR to source info

Use PAS and EPR to source info

Strengths EmLap Pathway EmLap pathway – access to EmLap CT and Cons reporting within EPR

Emlap booking form for risk scoring (currently P-POSSUM score)

Time to breach countdown on booking

Theatre Booking

Opportunities Encourage further surgical engagement

Introduce a formal ‘NELA time’ with WHO sign-out to improve data accuracy and completeness

Engage theatre nurses – setting up lead nurse role

Automatic email generation for elderly care

Replace P-POSSUM scoring with NELA risk score in booking process

Secretarial/Admin support for NELA/EmLap - improve section 7 and time to locking of cases

New EPR coming with more EmLap elements incorporated

Aspirations Improved and quicker locking of cases

Every surgeon, anaesthetist and all theatre staff engaged with accurate, in-theatre data entry

Best Practice Tariff achieved

Better understanding of urgency and improved accuracy of booking to improve decision to theatre times

Improved Elderly Care input

Perioperative input by Intensive Care Consultant if risk of death>10%

Accurate and timely feedback to staff to enable further QI

Results/Resources 100% case ascertainment

Excellent Critical Care bed availability

Time in NELA Leads’ job plans

Adjusted mortality rate 8.4%

Any questions?

The End