PTH-137 An Impact Analysis: Expansion of the Gastroenterology Reach in Service to Acute Medicine: Abstract PTH-137 Table 1

Abstract

IntroductionThe gastroenterology team at Watford General Hospital provides a daily reach in service to the acute medical department every weekday morning. The role of these reviews is to expedite specialist input to patients acutely admitted to the hospital with the aim of improving clinical outcomes and time to discharge.A proposal has been suggested to provide an evening service in addition with a gastroenterology reach in at 5 pm on weekdays to provide a second round of reviews to patients who may have been identified as needing specialist input since the morning round. In order to provide such a service resources (Consultant or Specialist Registrar time) will need to be diverted from other pressured clinical work such as clinics or endoscopy. The aim of this report is assess the potential utility of providing such a service so as to better inform future decisions on the topic.MethodsOn behalf of the gastroenterology department the author has collected data on patients flagged as requiring gastroenterological input on 7 consecutive weekdays from the 07/12/2015 to 15/12/2015. The notes were briefly reviewed and an assessment was made on the basis of this as to the likelihood of the patient being immediately discharged following specialist input.ResultsThere were no referrals for gastroenterology review on 3 of the 7 evenings assessed. The range of case numbers referred on other days was between 1 and 3. It was not felt that any of the patients would have had a same day discharge if gastroenterological review was provided due to a variety of factors such as frailty, pending radiological or serological testing or ongoing poorly controlled symptoms. The breakdown of patient demographics and presentations are summarised in the table below.Abstract PTH-137 Table 1DateAge and GenderPresentation or DiagnosisLikelihood of same day discharge08/12/201556 FemaleSuprapubic pain and UTINo08/12/201520 MaleCyclical vomiting syndromeNo11/12/201580 FemaleAnorexia and weight lossNo14/12/201557 FemaleDiarrhoea and vomitingNo15/12/201550 FemaleAbdominal painNo15/12/201561 MaleDecompensated CirrhosisNo15/12/201587 FemaleSepsis and deranged LFTsNoConclusionOverall in the authors opinion following analysis of the collected data an evening review is unlikely to result in a significant increase same day discharges. The likely time and resource commitment is probably unlikely to result in significant improvement in clinical outcomes given the already intense input the gastroenterology department has every weekday morning with the reach in services to the acute medical unit as well as the liaison the gastroenterology registrars provide for urgent cases in the afternoon and the provision of specialist opinion at local tertiary hospitals via telephone out of hours.Disclosure of InterestNone Declared