AB247. SOH26AB_0383. Optimising emergency laparotomy care through improved National Emergency Laparotomy Audit score utilisation at Cork University Hospital: a closed-loop audit

Background: The National Emergency Laparotomy Audit (NELA) score is a validated perioperative risk assessment tool recommended for all emergency laparotomy patients. It supports early identification of high-risk patients, guides senior clinical decision-making, and informs discussions around operative risk and consent. Proper use of the NELA score facilitates timely involvement of senior surgeons and anaesthetists, optimises critical care planning, and helps ensure appropriate postoperative monitoring. In addition, accurate NELA documentation contributes to national benchmarking, quality assurance, resource planning, and improved patient outcomes. Ensuring consistent use of the score is therefore essential for maintaining high standards of emergency surgical care. We performed a closed-loop audit of emergency laparotomy care.

Methods: A retrospective review of emergency laparotomy cases was conducted in two cycles: a first-cycle audit over 6 months, followed by targeted interventions, and a second-cycle re-audit over 3 months. Interventions included staff education, an intradepartmental presentation, email reminders to non-consultant hospital doctors (NCHDs), and poster distribution throughout hospital areas, including wards, theatre, the acute surgical assessment unit (SAU), and the emergency department. The NELA score was also added to the surgical admission note and handover documentation. Compliance with NELA documentation and utilisation was assessed against audit standards.

Results: The first-cycle audit demonstrated low compliance with NELA documentation and inconsistent application in perioperative decision-making. Following multifaceted interventions, the second-cycle re-audit showed significant improvement in both documentation and clinical use of the NELA score, demonstrating better alignment with national standards.

Conclusions: This closed-loop audit demonstrates that targeted, system-wide interventions can significantly improve compliance with NELA score documentation and utilisation in emergency laparotomy care. Ongoing auditing is recommended to ensure sustained progress, and the successful strategies used may be adopted across hospitals throughout Ireland. There is also a clear need to develop a national NELA framework for Ireland to standardise perioperative risk assessment and drive nationwide quality improvement

Keywords: National Emergency Laparotomy Audit score (NELA score); emergency laparotomy; perioperative risk; patient outcomes; emergency surgical care