Purpose

2018 reports from the Royal College of Surgeons and National Emergency Laparotomy Audit (NELA) have questioned the standard of care afforded to high-risk surgical patients by Radiology, primarily due to delays in the acquisition and reporting of CT imaging.

In response to suggestions of initiating trauma-pathway standards in this patient group, a “NELA” pathway was introduced in our busy tertiary centre.

Here, patients assessed by a senior clinician are fast-tracked for CT imaging within 30 minutes of arrival in hospital, without radiologist input. Reports should be available within 1 hour, with a discrepancy rate under 5%.

Whilst assessing our department’s compliance, we also consider whether this style of pathway is appropriate for these patients.

Material and methods

A 3 month retrospective data collection from patients with a ‘NELA’ CT request.

Results

Of 76 patients scanned, 95.8% had reports available pre-operatively, with 64.5% reported within 60 minutes (median time 51 minutes).

Paradoxically only 7.1% of CTs were requested within 30 minutes of arrival (mean time 4 hours 34 minutes).

68.6% of patients required no surgery, and only 14% received operations within 6 hours. Furthermore, 21% had no acute findings on CT.

Senior surgeons were three times more likely to correctly identify patients requiring emergency laparotomy, however they only assessed 16% of patients.

4% of CT scans were incorrectly protocolled.

Conclusion

Our data demonstrates that Radiology are not chiefly responsible for delays in this patient group. Closer multidisciplinary collaboration and communication is required in order to achieve appropriate and timely patient selection for a trauma-style pathway.