TTP8.11 Audit of Compliance, Documentation, and Score validity in Emergency Laparotomy Care: An overview of NELA scoring

Background This audit evaluated compliance with (NELA) standards, analyzed mortality outcomes, and examined the predictive utility of NELA scores. Emphasis was placed on preoperative risk assessment, documentation practices, and identifying gaps in care for emergency laparotomy patients. Methods A total of 57 cases were reviewed, collecting data on patient demographics, NELA mortality scores, and documentation of preoperative and postoperative management. Multidisciplinary team input and mortality risk communication were analyzed. The sensitivity and specificity of NELA scores for predicting mortality were assessed using a 10% threshold. Results Significant gaps in documentation practices were observed. Although NELA scores were preoperatively calculated in 94.7% of cases, mortality risk discussions were documented in only 17.86% of consent forms, suggesting limited communication of risks to patients or their next of kins. Elderly care team involvement was documented for just 12.5% of older patients (≥60 years). Critical care input was noted in 66.07% of cases, leaving a third without evidence of multidisciplinary collaboration. The NELA score demonstrated limited sensitivity (33.33%) for predicting mortality. While specificity was higher (84.31%), two-thirds of deceased patients were classified as low risk, raising concerns about the score’s reliability in identifying patients at risk of mortality. The overall mortality rate was 5.26%, with deceased patients being older (mean age 72.7 years). Conclusion The audit highlights substantial gaps in documentation, particularly in communicating mortality risks and involving elderly care teams. The limited sensitivity of NELA scores suggests the need for supplementary tools to improve risk prediction and care planning for emergency laparotomy patients.