Impact of an acute surgical unit on patient outcomes in South Australia

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Background: Few large Australian studies have explored the impact of acute surgical unit (ASU) model in appendicitis.Methods: An ASU model commenced practice at our institution on 1 August 2012. In this retrospective cohort study, patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. Primary outcomes were median length of stay, median time from emergency department referral to theatre start and proportion of cases performed in-hours. Secondary outcomes were rates of complications, open appendicectomy, consultant scrubbed for procedure, intensive care unit admission and re-presentation to emergency department within 30 days. Results: After removing those with incomplete data, 1214 patients were enrolled; 465 in the Traditional group and 749 in the ASU group. There were no significant baseline differences between groups. Compared with the Traditional group, ASU patients had similar length of stay (1.81 versus 1.81 days; P = 0.54) and time to theatre (0.59 versus 0.56 days; P = 0.14), but a greater proportion of in-hours operation (72% versus 79%; P = 0.014). The ASU group also experienced fewer complications (9% versus 6%; P = 0.031), fewer primary open (4% versus 1%; P < 0.0001) or conversion-to-open appendicectomies (6% versus 2%; P < 0.0005) and had superior rates of consultant scrubbed in theatre (21% versus 56%; P < 0.00001). Rates of intensive care unit admission (1% versus 1%; P = 0.72) and re-presentation were unchanged (5% versus 5%; P = 0.46). Conclusion: In our institution, the introduction of an ASU model was associated with more in-hours operations and safer care for patients undergoing appendicectomy.

Section: Introductionmentioning

confidence: 99%

Acute surgical unit improves outcomes in appendicectomy

Kinnear

Bramwell²,

Frazzetto

et al. 2019

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“…Rapid uptake of these systems nationally and internationally is likely driven by the published benefits of the ASU model. Patients frequently experience decreased time to theatre, length of stay and complication rates . Cost savings via an ASU model have been reported in the UK, the USA, Canada and Australia…”

Section: Introductionmentioning

confidence: 99%

“…Patients frequently experience decreased time to theatre, length of stay and complication rates. [6][7][8] Cost savings via an ASU model have been reported in the UK, 9 the USA, 10 Canada 11 and Australia. 12 However, the needs of surgeons and trainees have frequently been overlooked.…”

Section: Introductionmentioning

confidence: 99%

Does emergency general surgery model affect staff satisfaction, training and working hours?

Kinnear

Tran

Han

et al. 2019

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Background Few studies have assessed the relationship between different emergency general surgery models and staff satisfaction, operative experience or working hours. The Royal Australasian College of Surgeons recommends maximum on‐call frequency of one‐in‐four for surgeons and registrars. Methods A cross‐sectional study was conducted of all medium‐ to major‐sized Australian public hospitals offering elective general surgery. At each site, an on‐call general surgery registrar and senior surgeon were invited to participate. Primary outcomes were staff satisfaction and registrar‐perceived operative exposure. Secondary outcomes were working hours. Results Among eligible hospitals, 119/120 (99%) were enrolled. Compared with traditional emergency general surgery models, hybrid or acute surgical unit models were associated with greater surgeon and registrar satisfaction on quantitative (P = 0.012) and qualitative measures. Registrar‐perceived operating exposure was unaffected by emergency general surgery model. Longest duration on‐duty was higher among traditional structures for both registrars (mean 22 versus 15 h; P = 0.0003) and surgeons (mean 59 versus 41 h; P = 0.020). On‐call frequency greater than one‐in‐four was more common in traditional structures for registrars (51% versus 28%; P = 0.012) but not surgeons (6% versus 0%; P = 0.089). Data on average hours per day off‐duty were obtained for registrars only, and were lower in traditional structures (13 versus 15 h; P = 0.00002). Conclusion Hybrid or acute surgical unit models may improve staff satisfaction without sacrificing perceived operative exposure. While average maximum duration on‐duty exceeded hazardous thresholds for surgeons regardless of model, unsafe working hours for registrars were more common in traditional structures. General surgical departments should review on‐call rostering to optimize staff and patient safety.

“…At the RAH, patients with acute general surgical problems are admitted by the acute surgical unit (ASU). ASUs have been propagated throughout many tertiary Australian hospitals in the 21st century as a superior way to manage the emergency caseload with improved outcomes for clinicians and patients . The first to be developed was at Prince of Wales Hospital in 2005 .…”

Section: Introductionmentioning

confidence: 99%

“…ASUs have been propagated throughout many tertiary Australian hospitals in the 21st century as a superior way to manage the emergency caseload with improved outcomes for clinicians and patients. [3][4][5][6] The first to be developed was at Prince of Wales Hospital in 2005. 7 Core principles of an ASU are: an onsite consultant-led service with a defined period of on-call time, a rigid handover process and separation of emergency and elective surgery lists.…”

Section: Introductionmentioning

confidence: 99%

Lessons learned from relocating an acute surgical unit to a new quaternary referral centre in Adelaide, South Australia: a tale of two hospitals

Barnett

Finlay

et al. 2019

Background On 4 September 2017, patient care was relocated from one quaternary hospital that was closing, to another proximate greenfield site in Adelaide, Australia, this becoming the new Royal Adelaide Hospital. There are currently no data to inform how best to transition hospitals. We conducted a 12‐week prospective study of admissions under our acute surgical unit to determine the impact on our key performance indicators. We detail our results and describe compensatory measures deployed around the move. Methods Using a standard proforma, data were collected on key performance indicators for acute surgical unit patients referred by the emergency department (ED). This was supplemented by data obtained from operative management software and coding data from medical records to build a database for analysis. Results Five hundred and eight patients were admitted during the study period. Significant delays were seen in times to surgical referral, surgical review and leaving the ED. Closely comparable was time spent in the surgical suite. Uptake of the Ambulatory Care Pathway fell by 67% and the Rapid Access Clinic by 46%. Overall mortality and patient length of stay were not affected. Conclusion We found the interface with ED was most affected. Staff encountered difficulties familiarizing with a new environment and an anecdotally high number of ED presentations. Delays to referral and surgical review resulted in extended patient stay in ED. Once in theatre, care was comparable pre‐ and post‐transition. This was likely from early identification of patients requiring an emergency operation, close consultant surgeon involvement and robust working relationships between surgeons, anaesthetists and nurses.