Referrals to a Surgical Emergency Clinic in a District General Hospital

Abstract

Abstract Aims The referral pathway for the consultant-led Surgical Emergency Clinic (SEC) at our District General Hospital has no triage process. Anecdotally there are issues with inappropriate patients being booked for this clinic, taking up valuable slots and consultant time, and causing patient dissatisfaction. This was audited to see how the clinic is being utilised. Methods A retrospective case note review spanning 8 months looked at 250 patients seen in SEC. The origin of referrals, reason for referral, investigations, and clinic outcomes were recorded. Using this, patients were classified as ‘appropriate’ or ‘inappropriate’ for SEC. Results Referrals came from the following sources: 158 from general practice, 54 from the emergency department, and 38 directly from the surgical team. 58% were deemed to be appropriate referrals, while the remaining 42% were deemed inappropriate for SEC. 84 patients (33.6%) had imaging performed on the same day as their appointment, while 74 patients (30%) had investigations requested for a later date. 156 (62.4%) patients were discharged, 25 (10%) were redirected to a suitable surgical specialty outpatient clinic, and 16 (6.4%) were referred to other specialties. 10.4% had an acute surgical admission or same day CEPOD theatre, and 8.4% were listed for theatre on an elective/urgent basis. Conclusion This suggests SEC is not being used optimally and highlights a need to restructure the referral process. Physician Associates and Advanced Clinical Practitioners will be trained to assist consultants and triage referrals to improve patient flow, the efficiency of SEC, and hopefully the patient experience.