375 Introduction of a Physician Associate (PA) Led Surgical Ambulatory Emergency Clinic (SAEC) in the Highlands of Scotland

Abstract

Abstract Aim The delivery of surgical care in the Highlands has changed. SAEC was developed to alleviate bed pressures, improve patient satisfaction, and avoid unnecessary workload. We aim to identify whether SAEC is alleviating pressures in the surgical inpatient department - is it used appropriately and cost effectively. Method Attendance was collected prospectively (1/9/22 to 31/10/22) using a dedicated data audit book and booking diary. Patient’s individual review outcomes were gathered. Results Of the 165 patients referred to SAEC, 90% were reviewed by the PA, 10% only by the consultant. On average, 3.7 patients were seen per day. The referral reasons were wide ranging: 64 referrals for abdominal pain in addition to abscesses, constipation, weight loss, vomiting, stoma reviews and more. The age of patients ranged from 20-91. 61% were female. 46% had a scan. 85% received a diagnosis. 93% received definitive management. No patients made an unplanned re-presentation within the week following their review. The average time spent in SAEC per patient was 2 hours 48 minutes. 17% of patients were admitted, preventing 116 admissions. This saved approximately £45,820 through admission prevention. In addition, approximately a further £47492 was saved as this was PA led rather than consultant. Conclusions Prior to the employment of a PA, SAEC did not provide a consistent service, brought all patients to its surgical ward, and required employment of a second consultant. SAEC has improved patient flow and increased bed capacity whilst providing safe and high-quality care that is cost-effective.