Cohort study on emergency general surgery patients and an observation unit

Dickfos, Marilla; Ibrahim, Husam; Evans, Andrew; Franz, Robert

doi:10.1111/ans.13960

Cited by 3 publications

(6 citation statements)

References 15 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Twenty‐three articles from Australasia (Australia and New Zealand) described Acute Surgical Unit (ASU) models for the provision of acute care surgery [36–58]. ASU features that were repeatedly mentioned included a dedicated, consultant (attending)‐led ACS service, with clearance of the attending surgeon's elective workload, daytime on‐site attending coverage, 24/7 coverage by dedicated residents, and on‐call from home night‐time attending coverage.…”

Section: Resultsmentioning

confidence: 99%

Acute Care Surgery Models Worldwide: A Systematic Review

2020

View full text Add to dashboard Cite

Background The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles. Results The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care. Conclusions Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra-and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.

show abstract

Section: Resultsmentioning

confidence: 99%

Acute Care Surgery Models Worldwide: A Systematic Review

2020

View full text Add to dashboard Cite

show abstract

“…Its implementation has been instrumental in improving timely care to emergency surgical patients, with significant benefits in patient outcomes. 6,7,[15][16][17][18][19][20][21] Internationally, there has been an extensive drive to improve the time to review for surgical patients. Although there remains no clear agreement on an appropriate time frame, 30-min target times have been cited as a reasonable time after initial ED assessment.…”

Section: Discussionmentioning

confidence: 99%

“…A key feature of the ASU model is its consultant‐led service with a comprehensive handover system and dedicated emergency operating theatre. Its implementation has been instrumental in improving timely care to emergency surgical patients, with significant benefits in patient outcomes 6,7,15–21 . Internationally, there has been an extensive drive to improve the time to review for surgical patients.…”

Section: Discussionmentioning

confidence: 99%

“…The ASU is a dedicated consultant-led service that delivers prompt service provision, instil early management plans, reduce after-hours operating, and improve patient outcomes. [6][7][8] This mitigates the need for a surgical admitting unit (SAU) where patients are directly admitted to the ward before surgical review.…”

Section: Introductionmentioning

confidence: 99%

“…Prior to the ASU model, surgical patients at our institution were managed by a rotating roster of on‐call inpatient teams that manage a simultaneous elective workload. The ASU is a dedicated consultant‐led service that delivers prompt service provision, instil early management plans, reduce after‐hours operating, and improve patient outcomes 6–8 . This mitigates the need for a surgical admitting unit (SAU) where patients are directly admitted to the ward before surgical review.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Time to acute general surgical review: a retrospective study in a tertiary referral centre

Chan

Izwan

et al. 2023

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background: The Acute Surgical Unit (ASU) is a busy service receiving Emergency Department (ED) referrals for adult and paediatric general surgery care alongside trauma. The ASU model deviates from the traditional on-call model and has been shown to improve efficiency and patient outcomes. The primary aim was to evaluate time to surgical review ED presentation and general surgical referral. Secondary aims were to assess referral numbers, pathology and demographics at our institution. Methods: A retrospective observational analysis was conducted on all referral times from the ED to the ASU between 1 April and 30 September 2022. Patient demographics, triage and referral times, and diagnoses were collected from the electronic medical record. Time between referral, review and surgical admission were calculated. Results: A total of 2044 referrals were collected during the study period, and 1951 (95.45%) were included for analysis. Average time from ED presentation to surgical referral was 4 hours and 54 min with average time to surgical review from referral taking 40 min. On average, total time from ED presentation to surgical admission was 5 h and 34 min. Trauma Responds took 6 min to review. Colorectal pathology was the most commonly referred disease type. Conclusion:The ASU model is efficient and effective within our health service. Overall delays in surgical care may be external to the general surgery unit, or before the patient is made known to the surgical team. Analysis of time to surgical review is a key statistic in the delivery of acute surgical care.

show abstract

Patient Satisfaction in Emergency General Surgery: A Prospective Cross‐Sectional Study

et al. 2020

View full text Add to dashboard Cite

Background The importance of the patient experience is increasingly being recognised. However, there is a dearth of studies regarding factors affecting patient-reported outcomes in emergency general surgery (EGS), including none from the Southern Hemisphere. We aim to prospectively assess factors associated with patient satisfaction in this setting. Methods In this prospective cross-sectional study, all consecutive adult patients admitted to an acute surgical unit over four weeks were invited to complete a validated Patient-Reported Experience Measures questionnaire. These were completed either in person when discharge was imminent or by telephone \4 weeks post-discharge. Responses were used to determine factors associated with overall patient satisfaction. Results From 146 eligible patients, 100 (68%) completed the questionnaire, with a mean overall satisfaction score of 8.3/10. On multivariate analyses, eight factors were significantly associated with increased overall satisfaction. Five of these were similar to those previously prescribed by other like studies, being patient age [50 years, sufficient analgesia, satisfaction with the level of senior medical staff, important questions answered by nurses and confidence in decisions made about treatment. Three identified factors were new: sufficient privacy in the emergency department, sufficient notice prior to discharge and feeling well looked after in hospital. Conclusions Factors associated with patient satisfaction were identified at multiple points of the patient journey. While some of these have been reported in similar studies, most differed. Hospitals should assess factors valued by their EGS population prior to implementing initiatives to improve patient satisfaction.

show abstract

Cohort study on emergency general surgery patients and an observation unit

Abstract: General surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost-effective.

Cited by 3 publications

References 15 publications

Acute Care Surgery Models Worldwide: A Systematic Review

Acute Care Surgery Models Worldwide: A Systematic Review

Time to acute general surgical review: a retrospective study in a tertiary referral centre

Patient Satisfaction in Emergency General Surgery: A Prospective Cross‐Sectional Study

Contact Info

Product

Resources

About