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Chan E, Izwan S, Ng J, Swindon D, Teng R, Wong KSC, Cooper M. Time to acute general surgical review: a retrospective study in a tertiary referral centre. ANZ J Surg 2023. [PMID: 37147896 DOI: 10.1111/ans.18476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/22/2023] [Accepted: 04/09/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The Acute Surgical Unit (ASU) is a busy service receiving Emergency Department (ED) referrals for adult and paediatric general surgery care alongside trauma. The ASU model deviates from the traditional on-call model and has been shown to improve efficiency and patient outcomes. The primary aim was to evaluate time to surgical review ED presentation and general surgical referral. Secondary aims were to assess referral numbers, pathology and demographics at our institution. METHODS A retrospective observational analysis was conducted on all referral times from the ED to the ASU between 1 April and 30 September 2022. Patient demographics, triage and referral times, and diagnoses were collected from the electronic medical record. Time between referral, review and surgical admission were calculated. RESULTS A total of 2044 referrals were collected during the study period, and 1951 (95.45%) were included for analysis. Average time from ED presentation to surgical referral was 4 hours and 54 min with average time to surgical review from referral taking 40 min. On average, total time from ED presentation to surgical admission was 5 h and 34 min. Trauma Responds took 6 min to review. Colorectal pathology was the most commonly referred disease type. CONCLUSION The ASU model is efficient and effective within our health service. Overall delays in surgical care may be external to the general surgery unit, or before the patient is made known to the surgical team. Analysis of time to surgical review is a key statistic in the delivery of acute surgical care.
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Affiliation(s)
- Erick Chan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Sara Izwan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Justin Ng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Daisy Swindon
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Roy Teng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Kok Sum Chloe Wong
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Michelle Cooper
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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2
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Wong A, Burstow MJ, Yuide PJ, Naidu S, Lancashire RP, Chua TC. Comparative Analysis of Models of Care and Its Impact on Emergency Cholecystectomy Outcomes. J Laparoendosc Adv Surg Tech A 2022; 32:756-762. [PMID: 35041542 DOI: 10.1089/lap.2021.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background: The implementation of the acute surgical unit (ASU) model has been demonstrated to improve care outcomes for the emergency general surgery patient in comparison to the traditional "on call" model. Currently, only few studies have evaluated surgical outcomes of the ASU model in patients with acute biliary pathologies. This is the first comparative study of two different emergency surgery structures in the acute management of patients with acute cholecystitis and biliary colic. Methods: A retrospective review of patients who underwent emergency cholecystectomy for acute cholecystitis and biliary colic at two tertiary hospitals between April 2018 and March 2019 was conducted. Primary outcomes included length of hospital stay, time from admission to definitive surgery, and postoperative complications. Secondary outcomes include proportion of cases performed during daylight hours, length of operating time, rate of conversion to open cholecystectomy, and consultant surgeon involvement. Results: A total of 339 patients presented with acute biliary symptoms and were managed operatively. Univariate analysis identified a shorter mean time to surgery in the traditional group compared to the ASU group (29.2 hours versus 43.1 hours; P < .001). There was no difference in mean length of stay, operation duration between models, and postoperative complication rates between groups, with the majority of surgeries performed during daylight hours. The ASU group had a greater proportion of consultant-led cases (48.2% versus 2.5%, P < .001) compared to the traditional group. Conclusion: Patients with acute biliary pathology requiring laparoscopic cholecystectomy achieve equivalent surgical outcomes irrespective of the model of acute surgical care.
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Affiliation(s)
- Alixandra Wong
- Department of Surgery, QEII Jubilee Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew J Burstow
- Department of Surgery, Logan Hospital, Meadowbrook, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Peter J Yuide
- Department of Surgery, Logan Hospital, Meadowbrook, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Sanjeev Naidu
- Department of Surgery, QEII Jubilee Hospital, Brisbane, Australia
| | | | - Terence C Chua
- Department of Surgery, QEII Jubilee Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
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Barnett DR, Lu H, Finlay B, Coventry C, Granchi N, Marshall-Webb M, Heitmann P, Dobbins C. Lessons learned from relocating an acute surgical unit to a new quaternary referral centre in Adelaide, South Australia: a tale of two hospitals. ANZ J Surg 2019; 89:1620-1625. [PMID: 31637831 DOI: 10.1111/ans.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND On 4 September 2017, patient care was relocated from one quaternary hospital that was closing, to another proximate greenfield site in Adelaide, Australia, this becoming the new Royal Adelaide Hospital. There are currently no data to inform how best to transition hospitals. We conducted a 12-week prospective study of admissions under our acute surgical unit to determine the impact on our key performance indicators. We detail our results and describe compensatory measures deployed around the move. METHODS Using a standard proforma, data were collected on key performance indicators for acute surgical unit patients referred by the emergency department (ED). This was supplemented by data obtained from operative management software and coding data from medical records to build a database for analysis. RESULTS Five hundred and eight patients were admitted during the study period. Significant delays were seen in times to surgical referral, surgical review and leaving the ED. Closely comparable was time spent in the surgical suite. Uptake of the Ambulatory Care Pathway fell by 67% and the Rapid Access Clinic by 46%. Overall mortality and patient length of stay were not affected. CONCLUSION We found the interface with ED was most affected. Staff encountered difficulties familiarizing with a new environment and an anecdotally high number of ED presentations. Delays to referral and surgical review resulted in extended patient stay in ED. Once in theatre, care was comparable pre- and post-transition. This was likely from early identification of patients requiring an emergency operation, close consultant surgeon involvement and robust working relationships between surgeons, anaesthetists and nurses.
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Affiliation(s)
- Dylan R Barnett
- Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ha Lu
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ben Finlay
- Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Charlie Coventry
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nelson Granchi
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Marshall-Webb
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul Heitmann
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Chia CLK, Lu J, Goh SSN, Lee DJK, Rao AD, Lim WW, Tan KY, Goo JTT. Early laparoscopic cholecystectomy by a dedicated emergency surgical unit confers excellent outcomes in acute cholecystitis presenting beyond 72 hours. ANZ J Surg 2019; 89:1446-1450. [PMID: 31480096 DOI: 10.1111/ans.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/07/2022]
Abstract
BACKGROUND Early laparoscopic cholecystectomy (ELC) within 72 h of symptom onset is preferred for management of acute cholecystitis (AC). Beyond 72 h, acute-on-chronic fibrosis sets in rendering surgery challenging. This study aims to compare the outcomes of ELC for AC within and beyond 72 h of symptom onset by a dedicated acute surgical unit. METHODS This is a single-centre retrospective study of 217 patients with AC who underwent ELC by an acute surgical unit from January 2017 to August 2018. Outcomes collected include post-operative morbidity, length of hospitalization and operation duration. A subgroup analysis for the same outcomes was performed for elderly patients. RESULTS Of the 217 patients, 88 were operated within 72 h of symptom onset while 129 were operated beyond 72 h. Twenty-six patients received ELC after 7 days. There was no occurrence of bile duct injury. There was no statistical difference in conversion rates, wound infections and post-operative collections. Patients receiving ELC beyond 72 h had longer duration of operation (125.4 versus 116 min, P = 0.035) and length of hospitalization (4.59 versus 3.09 days, P = 0.001) without increase in morbidity. Patients older than 75 years had a higher incidence of post-operative collection (P < 0.001). CONCLUSION Patients with AC undergoing ELC by a dedicated acute surgical unit can have good outcomes even beyond 72 h of symptom onset. Meticulous haemostasis should be performed for the elderly subgroup of patients.
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Affiliation(s)
- Clement L K Chia
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Junde Lu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Serene S N Goh
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Daniel J K Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Anil D Rao
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Woan Wui Lim
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Kok-Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Jerry T T Goo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
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Cox DRA, Fong J, Liew CH, Goh SK, Yeoh M, Fink MA, Jones RM, Mukkadayil J, Nikfarjam M, Perini MV, Rumler G, Starkey G, Christophi C, Muralidharan V. Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute. ANZ J Surg 2018; 88:1337-1342. [PMID: 30414227 DOI: 10.1111/ans.14898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia. METHODS This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy. RESULTS A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort. CONCLUSION Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.
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Affiliation(s)
- Daniel R A Cox
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Jonathan Fong
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Chon Hann Liew
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Su Kah Goh
- Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Michael Yeoh
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Michael A Fink
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Robert M Jones
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Jude Mukkadayil
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Marcos V Perini
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Greg Rumler
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Graham Starkey
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Chris Christophi
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
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Wang E, Jootun R, Foster A. Management of acute appendicitis in an acute surgical unit: a cost analysis. ANZ J Surg 2018; 88:1284-1288. [PMID: 29998614 DOI: 10.1111/ans.14727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/15/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The acute surgical unit (ASU) model of acute general surgery care offers efficient patient assessment, improved clinical outcomes and has been demonstrated to be cost-efficient. Despite this, the management of acute appendicitis in our ASU was found to be highly cost-negative. This study sought to identify the drivers of increased cost. METHODS A retrospective cost analysis of all patients with uncomplicated acute appendicitis in 2016 was undertaken to investigate the drivers of increased cost. The patient-level costing approach was used to assign cost to patients. RESULTS The ASU management of uncomplicated appendicitis was found to have made a net loss of $625 000 in 2016. This study identified that the three largest cost drivers in appendicitis care were hospital overheads, bed day length of admission cost and operating theatre costs. Radiology, pathology and pharmacy costs did not affect total cost significantly. CONCLUSION Two key targets for improvement were identified. First, reduced theatre turnaround times will allow more efficient theatre utilization. Second, improved after-hours and weekend theatre availability will reduce preoperative waiting time-related cost.
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Affiliation(s)
- Edward Wang
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ravish Jootun
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Amanda Foster
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Kinnear N, Britten-Jones P, Hennessey D, Lin D, Lituri D, Prasannan S, Otto G. Impact of an acute surgical unit on patient outcomes in South Australia. ANZ J Surg 2017; 87:825-829. [PMID: 28681948 DOI: 10.1111/ans.14100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/06/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Compared with traditional (Trad) systems of managing emergency surgical presentations, the acute surgical unit (ASU) model provides an on-site registrar, on-call surgeon and dedicated emergency theatre, 24 h/day. To date, there have been no Australasian ASU studies of >3000 patients, nor from South Australia. METHODS A retrospective historical control study compared the outcomes of adults admitted to the Lyell McEwin Hospital in the Trad (1 February 2010 to 31 July 2012) and ASU periods (1 August 2012 to 31 January 2015), who underwent an emergency general surgical procedure. RESULTS A total of 4074 patients met inclusion criteria; 1688 and 2386 patients during the Trad and ASU periods, respectively. The cohorts were not significantly different in median age, gender or American Society of Anesthesiologists scores. Compared with the Trad period, improved median time from emergency department referral to theatre start (19.4 h versus 17.9 h, P < 0.0001) and median length of stay (2.32 days versus 2.06 days, P < 0.0001) were observed during the ASU period. The proportion of procedures performed in-hours was similar (77.9% versus 79.6%, P = 0.18). Secondary outcomes of rates of intensive care unit admission, emergency department representation within 30 days, in-hospital mortality and 1-year all-cause mortality were unchanged. CONCLUSION Institution of an ASU was associated with decreased time from referral to theatre and reduced length of stay. The proportion of cases performed in-hours did not change. This may be related to the high Trad period rate and increased workload. These findings represent the largest Australasian study of an ASU and support the current model of care.
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Affiliation(s)
- Ned Kinnear
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Philip Britten-Jones
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Derek Hennessey
- Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Diwei Lin
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Darren Lituri
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Subhita Prasannan
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Greg Otto
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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Tran S, Choi V, Hepburn K, Hewitt N, Zhou J, Chan DL, Talbot ML. Subspecialty approach for the management of acute cholecystitis: an alternative to acute surgical unit model of care. ANZ J Surg 2017; 87:560-564. [PMID: 28512772 DOI: 10.1111/ans.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional 'generalist' general surgery approach or the ASU model. METHOD A 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy. RESULTS Seven hundred emergency laparoscopic cholecystectomies were performed over this time. A total of 486 patients were available for analysis. The median time to operation was 2 days and median length of operation was 80 min. A total of 86.9% were performed during daylight hours. Eight cases were converted to open surgery (1.6%). Intra-operative cholangiography was performed in 408 patients. The major complication rate was 8.2%, including retained common bile duct stones (2.3%), sepsis (0.2%), post-operative bleeding (0.4%), readmission (0.6%), bile leak (2.1%), AMI (0.4%), unscheduled return to theatre (0.6%) and pneumonia (0.8%). There were no mortalities and no common bile duct injuries. CONCLUSION Over a time period that encompasses the current publications on the ASU model, a subspecialty model of care has shown consistent results that exceed established benchmarks. Subspecialty management of complex elective pathologies has become the norm in general surgery and this study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to ASU. Access block to emergency theatres delays treatment and prolongs hospital stay.
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Affiliation(s)
- Sonia Tran
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Vincent Choi
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Kirsten Hepburn
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Nathan Hewitt
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Joel Zhou
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Pillai S, Hsee L, Pun A, Mathur S, Civil I. Comparison of appendicectomy outcomes: acute surgical versus traditional pathway. ANZ J Surg 2014; 83:739-43. [PMID: 24099126 DOI: 10.1111/ans.12350] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The acute surgical unit (ASU) is an evolving novel concept introduced to address the challenge of maintaining key performance indicators (KPIs) in the face of an increasing acute workload. METHODS The aim of this retrospective study was to compare the performance of the ASU (from June 2008 to December 2010) at Auckland City Hospital with the traditional model (from January 2006 to May 2008) and benchmark the results against other similar published studies. The analysis was on the basis of KPIs for 1857 appendicectomies, which form a large volume of acute surgical presentations. RESULTS Our results show significant improvement in length of stay (2.8 days, 2.6 days, P = 0.0001) and proportion of daytime operations (59.4%, 65.8%, P = 0.004), in keeping with other studies on benchmarking. CONCLUSION The introduction of ASU has led to significant improvements in some KPIs for appendicectomy outcomes in the face of an increasing workload.
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Affiliation(s)
- Sandhya Pillai
- Acute Surgical Unit, Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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