Reports

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. 

To export these graphs to use in a presentation, press ctrl + print screen, and then ctrl + v (or right click and select paste) to paste into another document.

The dashboard is divided into the following sections

 

1. Data entry This section displays the number of records which have been started and the proportion which have been locked
2. Patient descriptors This section allows you to compare characteristics of your patients (Age, ASA, operative urgency and preoperative P-POSSUM predicted risk of death) with patients across the rest of England and Wales
3. Incomplete records Records that have not yet been locked can be identified using this section. NELA identifiers are listed to facilitate case locking
4. 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
5. Interval from decision to operate to arrival in theatre This section reports local and national average monthly interval from the time the decision was made to operate to arrival in the operating theatre. For cases where the time of decision to operate was not recorded and time of booking was provided, the latter is used for this analysis.

The upper and lower control limits (UCL and LCL) represent 3 standard errors either side of the overall mean. 99.7% of values would be expected to lie within these lines. If any of your monthly average values lie outside the lines, investigation of the underlying ‘special causes’ may assist quality improvement.

For further information about how to interpret Shewhart control charts this is a good place to start http://www.qihub.scot.nhs.uk/knowledge-centre/quality-improvement-tools/shewhart-control-charts.aspx

6. 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 (http://www.nela.org.uk/reports)
7. Presence of a consultant surgeon and a constant anaesthetist for surgery This section charts the monthly proportion of cases where both a consultant surgeon and a consultant anaesthetist were present in theatre during surgery
8. Consultant surgeon This section charts the monthly proportion of cases whose surgery was performed under the direct supervision of a consultant surgeon
9. Consultant anaesthetist This section charts the monthly proportion of cases whose perioperative care were delivered under the direct supervision of a consultant anaesthetist
10. 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
11. Critical care - Highest risk In this report you can review the monthly proportion of highest risk cases (assessed at end of surgery) who were admitted to a critical care unit directly after their initial emergency laparotomy

 

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 http://nela.org.uk/Standards-Documents  

‘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 “decision to operate” report take into account the volume of monthly cases and all cases of outlying data should be investigated.

NELA only analyses locked cases.  This is because until a record has been locked, it is possible to modify data fields.  We need to know that the data we report has not been subsequently been modified.  There may therefore be fewer cases reported than you expect.  The “Unlocked records” section helps you to identify the outstanding cases.

Analysis of the first year of patient data collection suggests that processes of care for patients who require expedited surgery (in >18hrs after the decision to operate has been made) are likely to significantly differ from those delivered to patients requiring more urgent surgery.  This is particularly true of the “Decision to operate” report.

The reports section therefore does not include expedited cases.  If you are interested in processes of care received locally by these patients, this data is available via the export function.

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 info@nela.org.uk 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