Pilot study of a new paradigm in the management of surgical emergencies using emergency surgery ambulatory care

Tierney, GM; Tou, Sio-Ian; Hender, J; Lund, J

doi:10.1308/rcsbull.2014.96.6.198

Cited by 11 publications

(9 citation statements)

References 1 publication

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“…30-day readmission rate in our unit was 1.8% and this rate was similar to the rate (1.6%) reported by Royal Derby Hospital [ 8 ]. As the unit managed patients on an ambulatory basis, we had many patients returning for tests or procedures.…”

Section: Discussionsupporting

confidence: 90%

“…In addition, AEC shares a lot of day case surgery principles [ 4 ], which makes implementing it in the surgical setting feel intuitive. Over the last few years, there have been different approaches to surgical AEC, with many hospitals reporting how they have managed to build their units and publishing their outcomes [ [6] , [7] , [8] , [9] , [10] ]. These experiences all shared the same aspiration for early assessment and early discharge of emergency surgical patients, facilitated by early input from a senior surgeon at the front door.…”

Section: Introductionmentioning

confidence: 99%

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Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service

Kazem

Hopley

Corless

2019

Annals of Medicine and Surgery

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Background Emergency surgical ambulatory care provides safe and effective assessment of acute surgical referrals, in addition to reducing the pressures on hospital beds. Our aim was to look at the effect of opening a surgical ambulatory care unit (SACU) and a dedicated surgeon for the unit on length of stay and same day discharge for emergency referrals. Methods Data was collected prospectively and updated daily to include all referrals to SACU. Historical data was retrieved to compare the effect of introduction of SACU and dedicated surgeon on same day discharge and length of stay. Results Three groups of patients were identified: pre-SACU, SACU and SACU with dedicated surgeon. There was 104.5% percentage increase in same day discharge rate for emergency GP referrals (22% pre-SACU to 45% in the dedicated surgeon group). Similarly, same day discharge for all emergency referrals increased from 17% pre-SACU to 29% in the dedicated surgeon group. There was 25.88 h reduction in the mean length of stay for emergency GP admissions (92.95 h pre-SACU to 67.07 h in the dedicated surgeon group). In pre-SACU group mean length of stay for all emergency admissions was 125 h, this dropped to 107.09 h in the dedicated surgeon group. This resulted in 102 hospital bed stays saved every month since the opening of SACU. Conclusions Establishing an emergency surgical ambulatory service has reduced length of stay and saved significant hospital bed stays. This effect was enhanced by having a dedicated senior surgeon providing early input and decision making.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service

Kazem

Hopley

Corless

2019

Annals of Medicine and Surgery

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“…Studies by Johnstone et al [7] & Tierney et al [8] found that a clinical ambulatory unit for emergency referrals is safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2020

AJBSR

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“…Tierney et al [5] also found very positive results in their management of surgical emergencies using emergency surgery ambulatory care (ESAC) and a dedicated on-call consultant to the surgical assessment unit. They quoted that in 4 months they had 377 patients suitable for the ESAC pathway.…”

Section: Discussionmentioning

confidence: 99%

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

Macano

Kirby

Lake

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundThere is increasing pressure on emergency services within the NHS requiring efficient, rapid assessment and management of patients. A subsequent reduction in hospital admissions reduces overall costs with an aim to improve quality of care. At the Royal Shrewsbury Hospital we run a one stop emergency surgical clinic. With strict criteria for admission to this clinic we have established a care pathway for those patients requiring urgent surgical review but not necessarily hospital admission.Materials and methodsWe reviewed our initial referral pathway to the emergency surgical assessment clinic. New guidelines were distributed to the local Care Coordination Centre (CCC) through which GP referrals to the clinic were made. A re-audit carried out 6 weeks later assessed change in clinical practice.ResultsWith the introduction of guidelines for referral we significantly increased the percentage of appropriate referrals to the one stop emergency surgical clinic (42.9%–79.4%, p = 0.000017). The majority (75.8%) of appropriate referrals can be successfully managed on an urgent outpatient basis. Appropriate referrals unsuitable for discharge from clinic had genuine reasons for admission such as abnormal results on assessment, or a need for surgery. 97.8% of referrals not deemed appropriate for the clinic were admitted for inpatient management.ConclusionBy providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

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Pilot study of a new paradigm in the management of surgical emergencies using emergency surgery ambulatory care

Cited by 11 publications

References 1 publication

Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service

Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service

Untitled

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

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