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Improving the Efficiency of the Emergency General Surgical Service

Improving the Efficiency of the Emergency General Surgical Service. Miss C Western Mr J W Faux Mrs M Feldman The Royal Cornwall Hospital, Truro. Our Unit:. Prior to 2007 : Emergency Surgical take run on a Consultant of the day model 8 consultants 10-bed SRU 4 Surgical inpatient wards.

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Improving the Efficiency of the Emergency General Surgical Service

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  1. Improving the Efficiency of the Emergency General Surgical Service Miss C Western Mr J W Faux Mrs M Feldman The Royal Cornwall Hospital, Truro

  2. Our Unit: • Prior to 2007 : • Emergency Surgical take run on a Consultant of the day model • 8 consultants • 10-bed SRU • 4 Surgical inpatient wards

  3. Change was needed • Reduction in Junior doctors hours • Full shifts Led to little continuity of care

  4. Service development • 2 further Consultants appointed • ‘Split week’ on-call model proposed • Expansion of SRU to 27 beds • 4x 6-bedded bays • 3x side room • Ultrasound room

  5. Principles:

  6. Responsibility for patient care passing forward on Monday and Friday am

  7. Allowing ongoing twice daily senior review for patients: • Under observation • Unstable & in need of monitoring • Likely to be discharged within a short time frame

  8. If discharged, OP F/U under care of transferring Consultant

  9. Benefits • Separation of elective and on-call services • Reduction in length of stay: N.B throughout this time admissions increased by 12%

  10. Dr Foster analysis for the 12 months from October 2007: Actual LOS = 2.1 days < predicted • Best figure country-wide • The next nearest being 1.7 days < predicted

  11. Average admissions = 16/day • Each day reduction in LOS = 16 less beds occupied by Surgical patients • Proved possible to close an inpatient ward, saving £1.2 million/yr

  12. Discussion: • Emergency patients account for > half surgical admissions & bed-days • Early assessment by consultants & rapid access to imaging ↓ admission rates & length of stay 1,2 • Combining all these factors → significant cost-savings & improved continuity of care

  13. Conclusion: • A consultant-delivered on-call service is a financially favourable model of care, reducing length of stay and an opportunity to improve training

  14. References: • Cochrane RA et al. Senior surgeons and radiologists should assess emergency patients on presentation: a prospective randomised controlled trial. J R CollSurg Eng. 1998; 43(5):324-7. • Britt WC, Weireter LJ, Britt LD. Initial implementation of an acute care surgery model: implications for timeliness of care. J Am Coll Surg. 2009; 209(4):421-4.

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