Acute Surgical Unit: a new model of care

Abstract

The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions.

Acute surgical unit safely reduces unnecessary after-hours cholecystectomy

“…In light of the preliminary results, trials of ASM implementation have been carried out in several institutions with mixed results. [1][2][3][4][5][6][7][8][9] The ASM was envisioned to allow a dedicated consultant-led team to manage acute surgical presentations efficiently and effectively. This coincides partly with the Australian healthcare service model that encourages greater patient flow in the emergency department.…”

Comparison of appendicectomy outcomes: acute surgical versus traditional pathway

“…KPIs are a means to quantify the outcomes of ASU when compared with the traditional model. 3 Our study has shown significant improvements in the LOS and proportion of daytime operations. The implication of these improvements in the efficiency of provision of care for appendicectomy patients are as follows: treatment when there is more expertise available during the daylight hours and shorter hospital stays.…”

“…It is inherent to the consultant-led ASU model that there is an increase in supervised training and other studies have demonstrated an improvement in training opportunities. 3 As the concept of acute care surgery is relatively novel, there are few studies comparing the traditional model with the acute care model. [1][2][3]26,27 KPIs have been identified as valuable in the evaluation of performance of ASU.…”

“…3 As the concept of acute care surgery is relatively novel, there are few studies comparing the traditional model with the acute care model. [1][2][3]26,27 KPIs have been identified as valuable in the evaluation of performance of ASU. 28 However, there is no established standardized approach to the comparison of outcomes following the introduction of an acute surgical model.…”

“…6,7 Previous comparisons of traditional and ASU models of surgical care have included comparison specific KPIs of length of stay (LOS), weekend discharge rates, time from referral to review, time to theatre (TTT) and proportion of daytime operations (Table 1). [1][2][3] The aim of this study was to compare the performance of the ASU at …”