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Introduction to the NELA Quality Improvement online reports

(Users need to login to access local data QI graphs)

This section of the webtool has been designed by the NELA Project Team to facilitate presentation and sharing of local NELA data and to support quality improvement in emergency general surgery. 

The dashboard is divided into the following sections

Data entry This section displays the number of records which have been started and the proportion which have been locked
Incomplete records Records that have not yet been locked can be identified using this section. NELA identifiers are listed to facilitate case locking
Cannot complete Some records cannot be completed (for example you later find out the case does not meet inclusion criteria or that it is an elective procedure). Records that have been identified to the NELA administrators will be reported in this section
Patient descriptors This section allows you to compare characteristics of your patients (Age, ASA, operative urgency and preoperative NELA predicted risk of death) with patients across the rest of England and Wales
Procedures In this section the top 10 Indications for surgery and the top 10 procedures are identified.  
Interval from decision to operate to arrival in theatre This section shows the time the decision was made to operate to arrival in the operating theatre, by surgical urgency (NCEPOD). 
Documentation of risk In this section you can review the proportion of cases for whom risk of death was documented before surgery. Assessment of risk is essential for informed consent and inter-professional communication. Analysis of the first year of patient data demonstrated that if risk of death was documented before surgery, delivery of Standards of care was more comprehensive (
Consultants present in theatre for high risk patients (>=5%) This section charts the monthly proportion of cases where both a consultant surgeon and a consultant anaesthetist were present in theatre during surgery. It only shows patients whose pre-operative estimated mortality* is >= 5%. 
Direct admission to critical care following surgery In this report you can review the monthly proportion of cases who were admitted to a critical care unit directly after their initial emergency laparotomy. It includes patients who did not die in theatre and were not palliated. The filter "High risk patients only >= 5%" uses the post-operative risk of mortality*
Length of Stay This section allows to review the post-operative length of stay by urgency of surgery (NCEPOD). It only includes patients surviving to discharge.  

*Estimated predicted mortality >= 5% - The NELA risk adjustment model and Clinical judgement are used to ascertain whether a patient was assigned to a high risk category (>=5%). If there is disagreement between these methods, the highest predicted risk category of the two is used. Where the NELA risk model is incomplete and cannot be calculated, the NELA Webtool will automatically assign the patient to a high risk category.

To export these graphs to use in a presentation, click on the menu button (3 lines), in the top right corner of the chart and select the format in which to export the chart.

Click here to read more on the charts available in the NELA Dashboard: NELA Online Reports Overview - Version 1.1


Important notes

NELA assesses the delivery of perioperative processes of care in emergency laparotomy against contemporary standards of care. These standards are available for viewing here

‘Average’ values may be misleading if small numbers of cases have been submitted, particularly in the presence of outlying data.  Please refer to your “Data entry” report and exercise caution interpreting results if fewer than 10 cases are included in a given month.  However, please also note that the control limits used in the control charts take into account the volume of monthly cases and so cases of data lying outside the control limits should be investigated. Click here to read more on control charts: NELA Online Reports Overview - Version 1.1

NELA can analyse locked and unlocked cases.  Please be aware that if looking at unlocked cases, the data may change before the record is locked. The “Unlocked records” section helps you to identify the outstanding cases.

Finally, this section has been designed to be used by the NELA participants who have made the Audit the success that it is today.  If you have suggestions or queries, please direct them to and we will do our best to get an answer to you as soon as possible.

If you are keen to work out your hospital’s observed: expected mortality, please refer to the resources available below:

-  Observed/Expected Mortality Ratio Calculation Explanation

-  Observed/Expected Mortality Ratio Calculation - Worked Example


NELA - Exception & Excellence Reporting

The spreadsheet below is intended to identify those patients that died before hospital discharge and display whether or not key standards of care were met (Exception Reports), or those patients for whom all applicable standards of care were met (Excellence reports). Please note that this report is NOT optimised to work on a Mac and we therefore recommend using a PC. 

Exception reporting UPDATED January 2020 - Updated Version

The hope is that you find these reports useful for your local data and can use them to disseminate information throughout your hospital site.