Impact of Acute Surgical Assessment Unit Dedicated Ultrasound Access at a Tertiary Care Hospital.

Shiori Kimura,Christina Fleming,Rishabh Sehgal,Shona Tormey,Laura Rouche,Muhammad Fahad Ullah

doi:10.7759/cureus.17294

Abstract

BackgroundDelayed diagnosis, unnecessary hospital admissions and extended length of stay are the problems associated with inappropriate access to radiological investigations. The acute surgical assessment unit (ASAU) in Limerick has two dedicated ultrasound scan (USS) slots daily to overcome this problem. The aim of the current study was to investigate the clinical impact on patient care and the cost-effectiveness of such an ASAU USS access.MethodsA retrospective review of all patients who underwent USS investigation in the ASAU between May and September 2017 was conducted. Demographic, referral source, presenting complaint, and clinical outcome data were obtained from the ASAU Log. USS data was obtained from the National Integrated Medical System (NIMIS). The Integrated Patient Management System (IPMS) and Therefore Case Manager, Therefore 2014(12.0.2) was utilized to check for any discharged ASAU patient re-presenting to the emergency department (ED) within 30 days. ResultsA total of 102 patients underwent USS investigation during the study period. The most common presenting complaint was epigastric or right upper quadrant pain (55.8%). Eighty-six patients underwent USS on the same day and the majority (51%) were discharged home with appropriate outpatient follow-up. Approximately 26,000 Euros were saved over four months. Post-discharge ED visits in the ASAU discharged group was zero in the 30 days. ConclusionThe ASAU USS dedicated slots in University Hospital Limerick has had a significant positive impact on patient diagnostics, surgical admissions rates and streamlining resource allocation. Having dedicated slots for radiological investigations in the ASAU should become standard of care across all healthcare jurisdictions.

Highlights

In 2009 Mid-Western Regional Hospitals Group underwent reconfiguration to improve patient safety and streamline provision and costs
Post-discharge emergency department (ED) visits in the acute surgical assessment unit (ASAU) discharged group was zero in the 30 days
Patients were identified from the ASAU log that is prospectively maintained by the Clinical Nurse Manager (CNM)

Summary

Introduction

In 2009 Mid-Western Regional Hospitals Group underwent reconfiguration to improve patient safety and streamline provision and costs. The centralisation of all emergency surgery to University Hospital Limerick (UHL) resulted in long waiting times in the emergency department (ED) and increased hospital admission rates One solution to this was the establishment of an acute surgical assessment unit (ASAU), a dedicated area where acutely ill surgical patients can be assessed and monitored prior to being admitted to the hospital or being treated and discharged. Prior to 2014, a large proportion of surgical referrals were admitted to UHL in order to undergo USS the day Such delays in diagnostics led to unnecessary hospital admissions and extended length of stay. Unnecessary hospital admissions and extended length of stay are the problems associated with inappropriate access to radiological investigations. The aim of the current study was to investigate the clinical impact on patient care and the cost-effectiveness of such an ASAU USS access

Objectives

Methods

Conclusion