Abstract
Abstract Background Dedicated Hot Gallbladder lists are proven to be cost effective and provide greater patient satisfaction. Unfortunately, the high volume of cases and the lack of available hospital resources make it very challenging to provide a consistent service. The aim of this study is to evaluate the safety and efficacy of the Registrar/SAS doctor led Hot Gallbladder service introduced in our Hospital over a year ago. Methods A system was developed with a middle grade doctor reporting to an UGI consultant surgeon and one SPOC in the waiting list office to streamline the service. A dedicated scoring system questionnaire (GalBAG form – Galbladder Booking and Grading form) was validated in retrospective and prospective series, and subsequently used to assess and grade patients into GOLD, SILVER & BRONZE cases based on expected difficulty and predicted length of the operation. Cases were listed based on surgeon compatibility. Outcomes measured include complications, unplanned admissions and re-admissions, need for further procedures, efficiency of the theatre lists and compared to national averages. Results Our registrar-led lists have successfully performed over 100 hot laparoscopic cholecystectomies. Complication rates, unplanned admissions, readmissions, and need for additional procedures align with national averages. Only one biliary injury occurred but was successfully treated endoscopically. The efficiency of the lists has improved with time as well as the ability to schedule progressively more complex cases Theatre utilization increased for patients referred through the Hot Gallbladder pathway. The GalBAG form accurately predicted difficulty and aided decision-making. Our Hospital now offers a secure and reliable Hot Gallbladder service, receiving positive feedback from patients and GIRFT. Conclusions In the current climate of increased waiting lists and lack of resources to provide dedicated urgent surgical services, a Registrar-led theatre list service with adequate backup/supervision could represent a safe, efficient, consistent and cost effective model to offer a Hot Gallbladder service.
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