Ahead of the curve: Implementation of the first twenty-four hour Acute Surgical Assessment Unit (ASAU) in Ireland

Fearon, Naomi; Ríogh, Aisling Nic An; Silvio-Esteba, L.; Awan, Faisal; Elfaedy, Osama; Pretorius, Fih

doi:10.1016/j.ijsu.2016.08.202

Cited by 3 publications

(4 citation statements)

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“…EGS in particular stands to benefit, where the volume of work continues to rise [16,17]. The ASAU model of care has shown promising results in other healthcare systems, particularly in Australasia, but remains a relatively new venture in Ireland [6,[8][9][10]. Our study shows the positive impact that the implementation of the ASAU may have on one of the most common clinical problems in EGS.…”

Section: Discussionmentioning

confidence: 84%

“…While the ASAU is a relatively new concept in the Irish healthcare system, the modest number of studies that focus on it have been favourable [6,[8][9][10]. However, these studies include a wide range of clinical conditions as part of a heterogenous case mix.…”

Section: The Asau In Irelandmentioning

confidence: 99%

“…While studies on the impact of the ASAU on EGS have largely been favourable, those available are largely from Australasia, and there have been conflicting reports regarding certain KPIs such as time to theatre and the proportion of procedures being performed outside of normal working hours [1]. As the ASAU remains a relatively new venture in Ireland, literature on its success and shortcomings remains limited [6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

Hannan

El‐Masry

2021

Ir J Med Sci

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Background Acute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional ‘on-call’ emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery. Aim We set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED. Methods Patients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts. Results In the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed. Conclusions The ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.

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Section: Discussionmentioning

confidence: 84%

Section: The Asau In Irelandmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

Hannan

El‐Masry

2021

Ir J Med Sci

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“…There has been limited interest in the last five years in an alternative EGS model; the Surgical Assessment Unit. 21 None have been reported in Australia. These roster an EGSdedicated surgeon in the emergency department, to whom patients with probable EGS diagnoses are referred by the emergency department triage nurse (or in some countries, general practitioners).…”

Section: Discussionmentioning

confidence: 99%

Emergency general surgery models in Australia: A cross-sectional study

Kinnear

Han

Tran

et al. 2019

amj

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Background Emergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. However, the EGS structures in most Australian hospitals remain unknown. Aims This study aimed to describe the national spectrum of EGS models. Methods Surgical staff were contacted in all Australian public hospitals of medium (>2,000 patient separations perannum) or greater peer group. Primary outcomes were incidence of each EGS model. Secondary outcomes were the relationship of EGS model to objective hospital variables, and qualitative reasons for choice of model. An ASU allocated a general surgeon solely to EGS patients for ≥50 per cent of business hours. A Hybrid model did not have this feature, but provided either a doctor-in-training rostered solely to EGS for ≥50 per cent of business hours, or ≥2 protected theatre half-day EGS lists per week. Results One hundred and nineteen of 120 eligible hospitals participated (99 per cent). Sixty-four hospitals (54 per cent) reported utilising hybrid model. ASU implementation was significantly more common amongst hospitals of greater peer group (p<0.0001), bed number (p<0.0001), surgeon pool (p=0.0003) and trauma service sophistication (p=0.0002). Leading reported drivers for ASU commencement were aims to improve EGS patient care and decrease after-hours operating, while common barriers against ASU uptake were insufficient EGS patient load or surgeon on-call pool. Conclusion ASU or Hybrid models of care for EGS patients may be more widespread than currently reported. Introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput.

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Emergency general surgery models in Australia: a cross-sectional study

Kinnear

Han

Tran

et al. 2020

Aust. Health Review

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ObjectiveEmergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. EGS structures in most Australian hospitals remain unknown. This study aimed to describe the national spectrum of EGS models. MethodsA cross-sectional study was performed of all Australian public hospitals of medium or greater peer group (>2000 patient separations per annum). The primary outcome was the incidence of each EGS model. Secondary outcomes were the relationship of the EGS model to objective hospital variables, and qualitative reasons for the choice of model. ResultsOf the 120 eligible hospitals, 119 (99%) participated. Sixty-four hospitals reported using an ASU (28%) or hybrid EGS model (26%), whereas the remaining 55 (46%) used a traditional model. ASU implementation was significantly more common among hospitals of greater peer group, bed number, surgeon pool and trauma service sophistication. Leading drivers for ASU commencement were aims to improve patient care and decrease after-hours operating, whereas common barriers against uptake were insufficient EGS patient load or surgeon on-call pool. ConclusionsASU or hybrid models of care may be more widespread than currently reported. The introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput. What is known about the topic?Traditionally, general surgical staff were rostered to elective operating and clinic duties, with emergency patients managed on an ad hoc basis. An ASU model, with a surgeon dedicated to EGS patients, has been associated with superior outcomes. However, the Australian uptake of this model is unknown. What does this paper add?This study enrolled 119 of 120 (99%) Australian public hospitals of medium or greater peer group (>2000 patient separations per annum). Uptake of the ASU or hybrid model was more widespread than expected, existing in 64 of 119 (54%) centres. Factors for and against ASU implementation were also assessed. What are the implications for practitioners?Hospitals considering implementing an ASU or hybrid model will be reassured by the common reports of improved patient outcomes and decreased after-hours operating. However, potential hospitals must assess the suitability of the ASU model to their surgeon pool and EGS patient load.

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Ahead of the curve: Implementation of the first twenty-four hour Acute Surgical Assessment Unit (ASAU) in Ireland

Cited by 3 publications

References 0 publications

The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

Emergency general surgery models in Australia: A cross-sectional study

Emergency general surgery models in Australia: a cross-sectional study

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