DOI: 10.1093/bjs/znad258.374 ISSN:

1202 National Emergency Laparotomy Audit (NELA): Difficulties Achieving the Best Practice Tariff (BPT) Criteria

B Chkir, P Patel, R Peris, G Lee, S Handa
  • Surgery



BPT is granted to trusts if “80% of their NELA-high-risk-patients have a Consultant Surgeon (CS) and a Consultant Anaesthetist (CA) present during surgery and were admitted directly to critical care–the same patient needs to have received both elements of care.” The aim is to assess the difficulties in achieving the BPT &compare outcomes of high-risk-NELA-patients in a DGH.


Retrospective review of all emergency laparotomy admissions from April 2019-August 2021.Only high-risk patients included. Data extracted from NELA-website &various sections across the hospital’s e-system.


Total of 166 cases;99 of which were classified as high-risk. 48-males & 51-female patients (age range 40-95). 100% of cases had CS present in theatre. 63% of cases had CA in theatre compared to 37% which had SAS-grade-anaesthetist. 87% were admitted to critical-care,9% to Patient-Progression-Unit (PPU/HDU) & 4% to wards. 82% of patients survived the admission:63% had CA in theatre compared to 37% which had SAS-grade-anaesthetist.86% patients admitted to critical-care,11% to PPU/HDU & 3% to wards.


57% of high-risk cases have met the BPT criteria compared to 43% which didn't:29-cases had no CA in theatre,6-cases were not admitted to critical-care & 8-cases were not admitted to critical-care & had no CA in theatre.

18-total mortalities:9 met BPT & 9 didn't meet BPT (7 had no CA in theatre and 2 were not transferred to ICU post-op).

81% of total cases supervised by SAS-grade-anaesthetist survived.82% of total cases supervised by CA survived.

The survival outcomes of both anaesthetist-grades are almost identical but isn't audited in NELA-reports (Changes to criteria if otherwise).

More from our Archive