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