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

Abstract

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.

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

“…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.…”

The Role of Outpatient Care Accreditation in Enhancing Foreign Patients’ Perception of Colombian Medical Tourism: A Quasi-experimental Design

“…However, data collection and focus groups’ most share ideas show that outpatient care accreditation contributes to foreign patients’ arrival in Colombia, suggesting that foreign insurers, not only from the U.S, rely on the Joint Commission International accreditation as a medical tourism driver. The results are by the study cited in the literature review 24 that accreditation by the Joint Commission International means that the patients surveyed report greater satisfaction in the second variable. Unlike the research cited in which the increase in care time by 21% is specified, this study confirms that accreditation in outpatient care has a positive impact on the evaluation of the second variable.…”

“…While much research remains to be done on this topic, there are clear arguments in favor of extending insurance benefits internationally. [24][25][26][27][28][29][30]37 It is important to consider obtaining similar accreditations in outpatient medical care from other healthcare accreditation organizations that contribute to diversifying Colombian medical tourist offer. However, the literature review does not highlight that hospitals consider obtaining other ambulatory care accreditations.…”

“…[21][22][23] A 2017 study analyzed the application of the 3 variables above in primary medical attention in 4 Joint Commission International-accredited hospitals located in South America. 24 The authors found that time spent in post-ambulatory care increased by 21%, and participants reported greater satisfaction with the second variable after the accreditation. They also indicate that outpatient accreditation contributed to enhancing clinical research protocols ambulatory collected data.…”

Total Quality Management to reduce cost and To Improve Quality Process in Education Institution

“…(Macano, 2017)  An ambulatory care clinic reduces hospital admission. (Macano, 2017) According to Macano, patients can be primarily directed as an urgent outpatient. It can reduce unsuitable recommendations of patients.…”