Lewisham and GreenwichGP Matters

New Surgical Assessment Units (SAU): Information for GPs

In January 2015, Lewisham and Greenwich NHS Trust opened a Surgical Assessment Unit (SAU) at University Hospital Lewisham, following the opening of the SAU at Queen Elizabeth Hospital in December 2014.

GPs can refer patients directly to the unit so they can receive early access to treatment and diagnostics from specialist surgical teams.

At University Hospital Lewisham (UHL), the SAU treats general surgical presentations. The SAU at Queen Elizabeth Hospital (QEH) accepts patients with a range of surgical and orthopaedic presentations (inclusion and exclusion criteria can be found below).

Patients will be assessed on the unit, and treated if appropriate, before being discharged home or admitted to a ward.

University Hospital Lewisham

The SAU consists of 4 trolleys located on Cedar Ward. Because of the large amount of elective work carried out at UHL, this location ensures that elective and emergency flows can, wherever possible, be separated for good logistical and clinical reasons – including easy access to lifts for theatre/imaging.

Queen Elizabeth Hospital

The SAU consists of 6 trolleys located within the AMU; this location ensures that patients are placed within a clinically safe environment where experienced staff and Doctors are available should the need arise for emergency surgical intervention.

Opening Times

The units are open 7 days a week from 08.00–19.00 and patients can be referred to the service either by their GP or by the Emergency Department.

The last admission will be 18.00.

Prioritising SAU Patients

If the patient is referred to radiology by the SAU for a CT or MRI scan, they will be prioritised at

the same speed as patients being referred by the Emergency Department.

Two ultrasound slots will be kept available for ‘same day scans’ for SAU patients on each site to facilitate early diagnosis and possible discharge.

The length of stay on the SAU should be no longer than 4 hours.

If the patient needs to be admitted, they will be transferred to a bed on the appropriate ward.

SAU Accommodation

Description of Service

(i) The On-call Surgical/T/O SHO (UHL) and Surgical SHO (QEH) are available to cover the unit; the On-call Registrar is also available to attend as required.

(ii) Following assessment by the surgical SHO/Registrar; further diagnostic testing may be requested e.g. CT/US.

(iii) Patients will be informed as soon as a differential diagnosis has been identified as to whether they will require admission to a surgical ward or can be discharged home.

(iv) Patients who can be safely discharged will be notified if any follow up is required. They will also be given a discharge summary letter to hand into their GP and where necessary any medications that the doctor requests.

(v) Patients who require hospital admission will have a bed identified on the most

appropriate ward.

Inclusion and Exclusion Criteria

Inclusion Exclusion

w Abcess w Appendicitis w Cholecystitisw Diverticulitisw Foreign Bodiesw IBS/Abdo painw Obstructive Jaundicew Wound infectionsw Prolapse (bowel)w Pseudo Obstructionw Stoma related conditionsw Ambulatory patients (e.g. Rigid sigmoidoscopy)w Dressing changes

w Obstetricsw Patients under 16 yearsw Haemodynamically unstable patientsw NEWS score of >5 or 3 in one

parameter that would fit into the amber “sick” level of amber scorew Exacerbation of COPD requiring

treatment in addition to the suspected surgical problemw Known C-DIFF/MRSAw Infective Diarrhoeaw Acute Confusion

University Hospital Lewisham:

To refer a patient to the SAU at University Hospital Lewisham, please contact the Surgical Registrar by:wCalling 020 8333 3000 and requesting the surgical registrarwCalling 020 8333 3000 and requesting to bleep 2000

Queen Elizabeth Hospital:

To refer a patient to the SAU at Queen Elizabeth Hospital, please contact the Surgical or T+O Registrar by:wCalling 020 8836 6000 ext 4127 wCalling 020 8836 6000 and requesting to bleep 308

How to refer to the SAU

Patient Pathway for GP Referrals

GP wishes to refer a patient to secondary care

REG in discussion with GP triages patient and agrees appropriate pathway

Nurse in Charge to contact GP and inform them of the time frame to send the patient in

(this may be earlier than agreed time between the GP and Registrar, but not later)

University Hospital Lewisham,Lewisham

Emergency Department SAU Assessment OPA Pathway

GP phones Surgical Registrar on-call on Tel 020 8333 3000 Bleep 2000

If patient requires emergency treatment that cannot be delivered in an SAU setting.

GP to contact LAS and arrange emergency transfer in line with normal practice.

w Patient needs access to the Surgical Assessment Unit to undergo urgent investigation and further assessment.

w Registrar to discuss with GP clinical time frame required for admission (eg within 2 hours, 4 hours or 6 hours).

w Registrar to bleep Nurse in Charge of SAU and inform them of patient.

If an alternative to a SAU presentation could be considered (eg: urgent OPA), Registrar to take patient details and instigate alternative pathway via usual routes.

GP phones Surgical or T+O Registrar on Call on Tel 020 8836 6000 Bleep 308 or ext 4127

Queen Elizabeth Hospital,Greenwich