ThTP8.7 Streamlining ambulatory management of emergency general surgery

Abstract

Abstract Aims There is a trend to increase ambulatory management of general surgical patients, both improve the experience and outcomes for patients, as well as reduce need for inpatient beds. Prior to 2019, our trust had no ambulatory service; during 2019 a clinic was opened, which was located remotely from the admissions ward, and as a result we were unable to direct the majority of patients to the clinic to support ambulatory management. We sought to assess the benefit of the clinic, and to co-locate the ward and ambulatory triage clinic to increase access of ambulatory management. Methods Admission rates were assessed before and after the ability to run virtually all patients through the ambulatory ‘triage’ clinic before making a decision to discharge or admit. Data have been used from electronical hospital systems. Results In 2019 the average number of patients reviewed was 18, with a 81% admission rate. Practice was variable during the COVID pandemic, once things stabilised in 2022, 25 patients were reviewed between clinic and the ward daily, with 16.2(65%) admission rate. The move of the ward and the clinic in 2022 did not change the total number of clinical contacts a day (25), however there is a reduction in the average percentage of patients staying overnight to 13.5(54%). Conclusions We have demonstrated that we can reduce the number of inpatient stays and reduce the length of stay of patients. The same day discharge rate was improved by allowing the majority of patients to be reviewed in the clinic, before a decision regarding admission was made.