Emergency general surgery 'Hot Clinics' reduce admission rates and duration of inpatient stay

Francesca Th'ng, Christos Skouras, Alice Paterson-Brown, Rajan Ravindran, Peter Lamb, Andrew de Beaux, Simon Paterson-Brown, Damian J Mole

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To determine the impact of a 'Hot Clinic' (HC) on emergency general surgery patient flow-through.

DESIGN: Prospective service evaluation study.

SETTING: HC is a four-bedded area coordinated by a specialist nurse. The HC consultant sees emergency patients referred from the emergency department, general practitioners or those in preceding 24 h considered suitable for interim discharge while awaiting investigations and HC reassessment.

PATIENTS: All patients with acute abdominal pain were evaluated in three 4 week groups: before (group 1), 1 month (group 2) and 6 months after the HC was introduced (group 3). Interhospital transfers, intrahospital ward referrals and trauma patients were excluded.

INTERVENTION: Introduction of consultant-led surgical HC every weekday afternoon.

MAIN OUTCOME MEASURES: Proportion of patients admitted under general surgeons, length of inpatient stay and the proportion of patients referred again within 3 months were investigated.

RESULTS: 1409 patients were referred, of which 1061 met the inclusion criteria: 307 in group 1, 326 in group 2 and 428 in group 3. There was no difference in gender distribution (p=0.759). Inpatient admissions were significantly reduced (85.0% vs 78.2% vs 54.4%; p<0.001) and the inpatient duration of stay was significantly shorter after HC introduction (median (IQR) (95% CI) 63.8 (29.0-111.6) (51.8 to 72.8) hours vs 48.8 (21.7-101.2) (42.0 to 55.6) hours vs 47.7 (20.9-92.7) (42.8 to 56.9) hours; p=0.011).

CONCLUSIONS: Emergency general surgery HCs are associated with significant reductions in admission rates and inpatient bed occupancy. This service redesign has the potential to dramatically relieve pressure on acute surgical services.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalFrontline Gastroenterology
Volume8
Issue number1
Early online date14 Dec 2015
DOIs
Publication statusPublished - Jan 2017

Keywords

  • Journal Article

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