WE6.3 This isn't going to hurt - an ambulatory model of management of patients with subcutaneous abscesses reduces use of general anaesthetic and bed days

Abstract

Abstract Aim Management of patients with subcutaneous abscesses is challenging. Once in hospital, the majority require incision and drainage (I&D), often under general anaesthetic (GA). Patients placed on emergency lists are frequently superseded, due to being systemically well, often staying overnight in hospital. We assessed how the establishment of a nurse-led, ambulatory service for I&D of abscesses reduced the need for GA, and impacted inpatient stay. Method Multiple digital sources were used to retrospectively collect data for all patients attending our centre for I&D of subcutaneous abscess during two time periods: August-October 2019 (prior to establishment of the ambulatory service) and August-October 2021 (a year after implementation of the service). Location I&D performed, mode of anaesthesia and length of stay were collected. Results In 2019, 102 patients underwent I&D; 87(85%) were drained under GA. In 2021, 73 patients were managed with I&D, but only 41(56%, p<0.001) required GA; 6(15%) cases were accommodated on a day surgery list. In 2019, 37(36%) patients were managed without overnight stay; in 2021 this rose to 46(63%, p<0.001). Extrapolating if an average of one patient requiring I&D attended each day, estimated bed days used per year dropped from 440 in 2019, to 215 in 2021. Conclusion Establishment of a nurse-led ambulatory pathway for I&D of skin abscesses safely and effectively reduces the number of general anaesthetics and inpatient bed days, potentially by half. Patients requiring anaesthetic support should be accommodated on planned day case lists where possible.