National audits, such as the National Emergency Laparotomy Audit (NELA), are a powerful tool. They allow us to see what is happening to our ‘real-life’ patients, to identify gaps in our local services, to see which hospitals are doing best and to share best practice. This learning informs guidelines and pathways such as ‘The High-Risk Surgical Patient’ and the forthcoming international enhanced recovery programmes for emergency laparotomy. The linking of good practice with a financial incentive, the Best Practice Tariff, has also acted as a carrot for hospitals to support funding for new models of care. Previously we have seen how audit, linked with guidelines and associated financial incentives, has improved outcomes in hip fracture and now it is encouraging to observe similar results in emergency laparotomy.
In this blog, Dr Jugdeep Dhesi, Consultant Geriatrician and Deputy Director for the Centre of Perioperative Care, discusses NELA and older patients, and how we must deliver patient-centred rather than surgical-speciality based pathways and to ensure the best outcomes for all of our patients.