General Surgeons Australia's 12‐point plan for emergency general surgery

Ang, Zhen Hao; Wong, Shing Wai; Truskett, Philip G.

doi:10.1111/ans.15327

Cited by 10 publications

(12 citation statements)

References 61 publications

(173 reference statements)

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“…The ASU model has been described as a consultant‐led service 3 . This principle aligns with the results of this study, which showed that a greater proportion of consultant cases were performed in the ASU cohort.…”

Section: Discussionsupporting

confidence: 82%

“…Time to the operating room has been described as a key benefit of the ASU model and is commonly implicated in superior patient outcomes 3,6 . The main reason behind reducing time to theatre is to improve overall clinical outcomes and patient care; prompt treatment of emergency cases leads to lower complication rates, lower risk of perforation and shorter hospital admissions 11 .…”

Section: Discussionmentioning

confidence: 99%

“…outlined a 12‐point plan for emergency surgery and some of the benchmarks of an acute surgical unit (ASU) model of care 3 . The main principles underlying the 12‐point plan described a consultant‐led process involving a rigorous handover and dedicated emergency theatre time with clear separation from elective surgery commitments 3 . The fundamental aim of this model is to improve clinical and patient outcomes for the acute surgical patient by reducing delays in treatment decision‐making and time to theatre.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

Gounder

Dissanayake

Burstow

et al. 2021

ANZ Journal of Surgery

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Background In Australia, there has been a shift from the traditional ‘on‐call’ surgical model to the ‘acute surgical unit’ (ASU) model to improve outcomes in acute general surgery. Using emergency appendicectomy as a standardized procedure, we aimed to identify the different patterns of care between these on‐call structures by comparing two metropolitan district hospitals; one that employs a traditional on‐call model and the other, which employ the ASU model. Methods Data on consecutive patients undergoing emergency appendectomies at the two hospitals (traditional and ASU model) between July 2018 and December 2018 were retrieved for retrospective review. Patient factors, preoperative factors, operative factors and post‐operative outcomes were collected and tabulated for comparative analysis between the traditional versus ASU model of care. Results Univariate analysis demonstrated that there were a greater proportion of consultant‐led cases (P < 0.001), a shorter time to theatre (P = 0.047) and a greater number of out‐of‐hours operations (P < 0.001) in the ASU model compared to the traditional model. A larger proportion of patients from the traditional model underwent a computed tomography scan as part of their diagnostic workup compared to the ASU model (P < 0.001). There was no difference in negative appendicectomy rates, intraoperative conversion rates, post‐operative complication rates or mean lengths of hospital stay between the two on‐call models. Conclusion The ASU and traditional on‐call model appears to achieve equivalent care outcomes for patients with acute appendicitis.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

Gounder

Dissanayake

Burstow

et al. 2021

ANZ Journal of Surgery

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“…19 Therefore, General Surgeons Australia advocates for emergency surgery to be performed during the working day unless there is a threat to life, limb or organ. 20 An ACS model of care can help achieve this goal in theory 21 and, as this study shows in relation to appendicectomy, in practice as well.…”

Section: Discussionmentioning

confidence: 85%

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Kaya

Yang

Wong

et al. 2020

ANZ Journal of Surgery

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Background Many hospitals across Australia and New Zealand have implemented acute care surgery (ACS) models over the past decade, often with improved outcomes such as reductions in wait time to surgery, complications and length of stay. The aim of this study was to evaluate the outcomes of patients who underwent non‐elective appendicectomy and cholecystectomy and compare these with the results observed shortly after the implementation of an ACS model at our institution 10 years earlier. Methods A retrospective review of contemporary patients who underwent non‐elective appendicectomy and cholecystectomy compared with historical data was performed. Primary outcomes were wait time to surgery, surgical complications and length of stay. Results In the contemporary cohort, 263 patients underwent non‐elective appendicectomy over a 1‐year period compared with 226 patients in the historical cohort. The median wait time to surgery had increased (17.7 versus 9.6 h, P < 0.001). There was no significant difference in a composite end‐point of complications and readmissions (8.0% versus 9.3%, P = 0.61). The length of stay was unchanged. There was greater use of preoperative imaging and reduced overnight operating. For non‐elective cholecystectomies, 132 patients underwent this procedure in the contemporary cohort over a 2‐year period compared with 115 patients in the historical cohort. There were no significant differences in wait time to surgery (2 versus 1 day, P = 0.13) or complications (9.8% versus 8.7%, P = 0.75). The length of stay was unchanged. Conclusion The majority of improvements seen shortly following the implementation of an ACS model have been sustained after 10 years.

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“…However, we found that extensive national and international heterogeneity exists in the structure of ACS models, most likely due to discrepancies in healthcare environment, hospital infrastructure, and available resources [26]. We identified relevant structural components of ACS services using the criteria for ACS models formulated by the AAST Committee for Acute Care Surgery, the GSA 12-point plan (Table 3), and components frequently reported in the ACS literature (Table 2) [3,71]. Previous systematic reviews have focused on clinical and financial outcomes of ACS models [21].…”

Section: Discussionmentioning

confidence: 99%

Acute Care Surgery Models Worldwide: A Systematic Review

2020

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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.

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General Surgeons Australia's 12‐point plan for emergency general surgery

Cited by 10 publications

References 61 publications

Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

Outcomes of an acute care surgery model: a 10‐year follow‐up study

Acute Care Surgery Models Worldwide: A Systematic Review

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