surgical ambulatory emergency care case study craigavon
TRANSCRIPT
Surgical Ambulatory Emergency Care
Case Study – Craigavon Area
Hospital
Ambulatory Care Craigavon Emergency Surgical ServiceACCESS
Susan Yoong Consultant General Surgeon
Craigavon Area Hospital
The Challenge
Lack of bed availability
Cancelled operations
Prolonged inpatient wait for investigations,
theatre
The Aim
To develop a new model to provide safe and
efficient patient care whilst avoiding unnecessary
admissions, promote decreased length of stay
and improve patient experience
ACCESS
Then
• 19:00 ED perianal pain
£375
• No space on e list
£375• I+D
abscess 22:00
£375
Now
• ED 19:00 Perianal pain
Home
• Hot clinic• I+D on EGS list• Home later
-3 bed days
-£1125
ACCESS
• 12 month period
March 2017– February 2018
• Data capture
ACCESS Diary
NIECR
Theatre Management System
• 5 DNAs (Excluded)
• 264 patients
• 156 Female
• 108 Male
• Average age 40.1 (14 – 83) yrs
Results
44%
12%
10%
8%
4%
4%
3%
3%3%
3%2% 1%1%
1%
1% Presenting ComplaintRUQAbscessRIF painHernia/groin painReviewWound problemsAbdominal PainEpigastric painLIF PainSebaceous CystVascularPerianal FistulaPR Bleeding
ACCESS USS 149/264 (56.4%)
41%
30%
15%
5%
3%3% 2%2%
GallstonesNormalFatty LiverGB PolypsHaemangiomaRenal CystThickened GBGB not seen
118/149(79.2%) for RUQ pain
0%
25%
50%
75%
100%
ACCESS Patients
Admitted
Outcomes
ACCESS List
Average Length of Stay = 1.25 dys
EMERGENCY List
Average LOS = 1.69 dys
Operations
ACCESS LIST ( “Hot List”)
32%
18%
2%
14%
5%
7%
5%
9%
2%2% 2% 2%Procedures
Lap Chole
Lap Appendix
Open Appendix
I+D Abscess
Flexible Sigmoidoscopy
Hernia repair
Inguinal L.N. Bx
EUA anorectum
Excision Seb. Cyst
Deltoid Muscle Bx
Right Hemicolectomy
Reversal of Loop Ilesotomy
Abscesses
Decreased time to theatre
Decreased Length of stay
Decreased out of hours operating
SummaryAdmission avoided in 80%
At Least 264 Bed stays saved in 12 months
£375 per Bed stay
= £99,000 / annum
Decreased LOS for ACCESS list
What Next?
Diagnostics - CT, MRCP
Establish “Virtual List”
Accelerated Discharges
Emergency Surgical Nurse Specialist