Increasing efficiency in emergency surgical care

Abstract

In response to increases in emergency surgical admissions, the Royal College of Surgeons of England (RCSE) published guidelines on ways to separate inpatient emergency and elective surgery with the creation of the surgical assessment unit (SAU). This study aimed to evaluate the impact of a new SAU on acute surgical patient pathways in a busy district general hospital and compare it with the RCSE standard for emergency care. Data were retrospectively extracted from records for all patients attending the SAU over an 8-week period. Patient demographics, methods of referral, rate of discharge, time spent in the SAU, imaging, diagnosis and the requirement for emergency surgical intervention were looked at. During the period studied there were 956 attendees, who spent an average time of 5 hours 48 minutes in the unit. Forty nine percent were admitted and of these, 41% required emergency surgery, with a further 18% of patients (60) re-attending the next day for emergency surgery. A total of 316 radiological investigations were conducted on the SAU patients. The average waiting time for a scan was 5 hours and 3 minutes. The majority of referrals were from GPs (38.5%). The SAU at Watford hospital is meeting the majority of the RCSE's guidelines, however there are several areas in which the unit can continue to improve. With hospitals under increasing pressures, this unit highlights a service where patients can be diverted from A&E to a dedicated assessment area, which is key to the future efficiency of emergency surgical care.