Effect of handover on the outcomes of small bowel obstruction in an acute care surgery model

Lien, I N; Wong, Shing Wai; Malouf, Phillip; Truskett, Philip G.

doi:10.1111/j.1445-2197.2012.06248.x

Cited by 16 publications

(30 citation statements)

References 37 publications

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“…In an Australian survey, 65% (total of 88 surgeons) of surgeons who responded were satisfied with the handover they received from their colleagues. Handing over patients did not affect patient outcome in the ASU model of care . For small bowel obstruction cases, delaying surgery until the next day and handing over of patients with unresolved uncomplicated small bowel obstruction were shown to decrease after‐hours operating, without an increase risk in need for small bowel resection or complication rates …”

Section: Review Of Gsa 12‐point Planmentioning

confidence: 95%

“…53,54 For small bowel obstruction cases, delaying surgery until the next day and handing over of patients with unresolved uncomplicated small bowel obstruction were shown to decrease after-hours operating, without an increase risk in need for small bowel resection or complication rates. 54 With the evolution of electronic medical records, handovers can be done with greater efficiency as clinical notes, pathology results and medical imaging are all available within a single portal. The timing and information which is handed over to the new surgeon can be documented so that there will be no confusion.…”

Section: Egs Should Be Consultant Ledmentioning

confidence: 99%

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General Surgeons Australia's 12‐point plan for emergency general surgery

Ang

Wong

Truskett

2019

ANZ Journal of Surgery

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In the last decade, emergency general surgery (EGS) in Australia and New Zealand has seen a transition from the traditional on‐call system to the acute surgical unit (ASU) model. The importance and growing demand for EGS has resulted in the implementation of the General Surgeons Australia's 12‐point plan for emergency surgery. Since its release, the 12‐point plan has been used as a benchmark of a well‐functioning ASU, both locally and abroad. This study aims to provide a descriptive review on the relevance of the 12‐point plan to the ASU model and review the current evidence to support this framework. The review concludes that the establishment of the ASU model has met the aims set out by the Royal Australasian College of Surgeons for EGS. The 12‐point plan is relevant and has good evidence to support its framework.

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Section: Review Of Gsa 12‐point Planmentioning

confidence: 95%

Section: Egs Should Be Consultant Ledmentioning

confidence: 99%

General Surgeons Australia's 12‐point plan for emergency general surgery

Ang

Wong

Truskett

2019

ANZ Journal of Surgery

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“…To our knowledge, three studies have assessed the impact of the ASU model on the management and outcomes of SBO . Lien et al .…”

Section: Discussionmentioning

confidence: 71%

“…Demonstrated benefits included reduced time to theatre and overall hospital stay, decreased after‐hours operation, use of preoperative computed tomography (CT) imaging and post‐operative complications . To our knowledge, only three small studies have analysed the impact of the ASU on the management and outcomes of SBO . Recent meta‐analysis has found that the data regarding the management of SBO is insufficient …”

Section: Introductionmentioning

confidence: 99%

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

Musiienko

Shakerian

Gorelik

et al. 2015

ANZ Journal of Surgery

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Background: The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. Methods: A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Results: Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). Conclusion:The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change.

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“…This new model of care was presumed to improve outcomes compared to the traditional method of covering EGS with an on call general surgeon (4, 5, 6). Since ACS was first conceptualized as a novel model of care, several single-center retrospective studies have shown improved outcomes after implementation of ACS for a number of non-trauma surgical emergencies including appendicitis (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17). …”

Section: Introductionmentioning

confidence: 99%

The impact of acute care surgery on appendicitis outcomes

Madore

Collins²,

Aytürk³

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Acute appendicitis is the most common indication for emergency general surgery (EGS) in the US. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute appendicitis at a national sample of university-affiliated hospitals. Methods We surveyed senior surgeons responsible for EGS coverage at University HealthSystems Consortium (UHC) hospitals, representing >90% of university-affiliated hospitals in the US. The survey elicited data on resources allocated for EGS during 2013. Responses were linked to UHC outcomes data by unique hospital identifiers. Patients treated at hospitals reporting hybrid models for EGS coverage were excluded. Differences in interventions and outcomes between patients with acute appendicitis treated at ACS hospitals vs. hospitals with a general surgeon on-call model (GSOC) were analyzed using univariate comparisons and multivariable logistic regression models adjusted for patient demographics, clinical acuity, and hospital characteristics. Results We found 122 hospitals meeting criteria for analysis where 2,565 patients were treated for acute appendicitis. 48% of hospitals had an ACS model (N =1414), and 52% had a GSOC model (N=1151). Hospitals with ACS models were more likely to treat minority patients with greater severity of illness than GSOC models. Patients treated at ACS hospitals were more likely to undergo laparoscopic appendectomy. In multivariable modeling of patients who had surgery (N=2,258), patients treated at ACS hospitals had 1.86 [95%CI 1.23,2.80] greater odds of undergoing laparoscopic appendectomy. Conclusion In an era when laparoscopic appendectomy is increasingly accepted for treating uncomplicated acute appendicitis, particularly in low risk patients, it is concerning that patients treated at GSOC model hospitals are more likely to undergo traditional open surgery despite having less severity of illness at the time of presentation. Furthermore, hospitals with ACS are functioning as safety net hospitals for vulnerable patients with acute appendicitis. Level of Evidence III

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Effect of handover on the outcomes of small bowel obstruction in an acute care surgery model

Cited by 16 publications

References 37 publications

General Surgeons Australia's 12‐point plan for emergency general surgery

General Surgeons Australia's 12‐point plan for emergency general surgery

Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction

The impact of acute care surgery on appendicitis outcomes

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