A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital

Abstract

Abstract Aims Patients presenting with emergency general surgical (EGS) conditions require urgent management - however, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management. Having a direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays - leading to better outcome in management of these patients. Methods A retrospective observational study of EGS admissions in May 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome. Results A total of 188 referrals were made to SEAU, of which 46 (24.5%) were DAP referrals. The average number was 18 over weekdays and 10 over weekends - of these, 97.8% of referrals were appropriate with correctly filled out proforma, whereas 2.2% were inappropriate referrals. 33% patients were discharged, 10% were admitted, and 10% were planned to return for investigations the following day. The median waiting time for initial assessment was 1.5hours. The most common presentations were RUQ Pain, subcutaneous abscess and RLQ pain which correlated with the final diagnosis. It was also noticed that when compared with May 2022 (176patients during the same 2-week period), there was 6.8% increased referral since commencement of DAP. Conclusion The DAP for EGS admissions has been seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.