The acute surgical unit: An updated systematic review and meta-analysis

Kinnear, Ned; Jolly, Samantha; Herath, Matheesha; Han, Jennie; Tran, Minh; O’Callaghan, Michael; Hennessey, Derek; Dobbins, Christopher; Sammour, Tarik; Moore, James W.

doi:10.1016/j.ijsu.2021.106109

Cited by 10 publications

(9 citation statements)

References 74 publications

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Section: Introductionmentioning

confidence: 99%

“…Whilst historically these patients may not have received surgical review, the broad uptake of the Acute Surgical Unit (ASU) model in Australia since 2005 has resulted in early review by general surgical teams with the aim of improving patient outcomes 4,5 . Convincing evidence supports this model of surgical care with studies demonstrating a decreased mortality rate, lower mean times to surgical review and theatre, as well as decreased complication rates and hospital length of stay for patients treated by ASU teams compared with traditional on‐call systems 4–6 . This change in service provision, in combination with an increasing rate of AAP presentations over time, 7 has resulted in general surgical teams being increasingly involved in the care of patients presenting with undifferentiated AAP, including those likely to be labelled as having NSAP.…”

Section: Introductionmentioning

confidence: 99%

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Rare causes of abdominal pain: a primer for the admitting general surgeon

Hamilton

Milenkovski

Martin

et al. 2023

ANZ Journal of Surgery

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The broad uptake of the acute surgical unit (ASU) model of surgical care in Australia has resulted in general surgeons becoming increasingly involved in the management of patients with acute abdominal pain (AAP), some of whom will be labelled as having non‐specific abdominal pain (NSAP) (Kinnear N, Jolly S, Herath M, et al. The acute surgical unit: An updated systematic review and meta‐analysis. review. Int. J. Surg. 2021;94:106109; Lehane CW, Jootun RN, Bennett M, Wong S, Truskett P. Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J. Surg. 2010;80:438‐42). NSAP patients lack a clear diagnosis of surgical pathology based on standard clinical, laboratory and imaging work‐up, although they may require ASU admission for pain control and assessment. This article provides a review of uncommon conditions, presenting as AAP, that could possibly be mis‐labelled as NSAP, with a focus on aspects of the presentation that may aid diagnosis and management including specific demographic features, clinical findings, key investigations and initial treatment priorities for ASU clinicians. Ultimately, most of the conditions discussed will not require surgical intervention, however, they require a diagnosis to be made and initial treatment planning before on‐referral to the appropriate specialty. For the on‐call general surgeon, some knowledge of these conditions and an index of suspicion are invaluable for the prompt diagnosis and efficient management of these patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rare causes of abdominal pain: a primer for the admitting general surgeon

Hamilton

Milenkovski

Martin

et al. 2023

ANZ Journal of Surgery

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“…The AGSU model was developed after observing an increase in key performance indicators including length of stay (LOS), time to surgical review in emergency department (ED), time to operating theatre and outcomes in general surgery, as well as an objection to the conflicting demands of balancing emergency and elective surgery with increased after hours operating that would potentially result in suboptimal care [3][4][5]. Initially developed in 2005 in the Prince of Wales Hospital in Sydney, then adopted by the Nepean hospital in 2006, it is now utilised across Australia and overseas [3,4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Inefficient Admissions for Abdominal Pain Under an Acute General Surgical Unit

Panwar¹,

Shan²,

Owens³

et al. 2023

World j. surg.

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Background The acute general surgical unit (AGSU) model has become a standard of efficient acute surgical care. Whilst the AGSU has been compared to the traditional surgical model, there is a lack of research auditing referrals and admissions. This study evaluates abdominal pain referrals to AGSU and the necessity of admission. Methods A retrospective cohort study of adult abdominal pain admissions was conducted over a two-year period at a single centre in metropolitan Victoria, Australia. The data were extracted from electronic medical records and key endpoints of data included the diagnosis, length of stay, investigations and subjective pain outcomes. Results A total of 1587 patients met the study criteria of which 1116 (70.3%) had a non-surgical diagnosis with the majority having non-specific abdominal pain. The non-surgical patients had a lower median length of stay (25.3 h) compared to surgical patients (44.2 h, p < 0.001). They were less likely to have an abnormal haemoglobin (p = 0.004), elevated white cell count (p = 0.02) or elevated C-reactive protein > 50 mg/L (p < 0.001). On multivariable analysis, surgical patients had higher odds of having a CRP > 50 mg/L (p = 0.024) and a positive imaging result (p < 0.001). The patient’s pain control also correlated with length of stay. Conclusion A large population of patients with non-specific abdominal pain are admitted to AGSU. These patients do not require surgery and have a short length of stay. Incorporating a negative CRP result and negative imaging result may be utilised in conjunction with optimised analgesia to help avoid these unnecessary admissions, thereby improving AGSU efficiency and workload.

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“…The National Emergency Access Target (NEAT) aims to improve patient access to public hospital EDs, by establishing financial incentives for EDs to complete a patient's care within 4 h. 1,2 In January-March 2022, only 30% of all medical and surgical admissions to our institution were completed within 4 h. 3 The Acute Surgical Unit (ASU) is a shift from the traditional model for management of acute general surgical patients, and has been successfully employed in Australia, the United Kingdom, the United States, and Canada. 4,5 Prior to the ASU model, surgical patients at our institution were managed by a rotating roster of oncall inpatient teams that manage a simultaneous elective workload. The ASU is a dedicated consultant-led service that delivers prompt service provision, instil early management plans, reduce after-hours operating, and improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…The Acute Surgical Unit (ASU) is a shift from the traditional model for management of acute general surgical patients, and has been successfully employed in Australia, the United Kingdom, the United States, and Canada 4,5 . Prior to the ASU model, surgical patients at our institution were managed by a rotating roster of on‐call inpatient teams that manage a simultaneous elective workload.…”

Section: Introductionmentioning

confidence: 99%

Time to acute general surgical review: a retrospective study in a tertiary referral centre

Chan

Izwan

et al. 2023

ANZ Journal of Surgery

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Background: The Acute Surgical Unit (ASU) is a busy service receiving Emergency Department (ED) referrals for adult and paediatric general surgery care alongside trauma. The ASU model deviates from the traditional on-call model and has been shown to improve efficiency and patient outcomes. The primary aim was to evaluate time to surgical review ED presentation and general surgical referral. Secondary aims were to assess referral numbers, pathology and demographics at our institution. Methods: A retrospective observational analysis was conducted on all referral times from the ED to the ASU between 1 April and 30 September 2022. Patient demographics, triage and referral times, and diagnoses were collected from the electronic medical record. Time between referral, review and surgical admission were calculated. Results: A total of 2044 referrals were collected during the study period, and 1951 (95.45%) were included for analysis. Average time from ED presentation to surgical referral was 4 hours and 54 min with average time to surgical review from referral taking 40 min. On average, total time from ED presentation to surgical admission was 5 h and 34 min. Trauma Responds took 6 min to review. Colorectal pathology was the most commonly referred disease type. Conclusion:The ASU model is efficient and effective within our health service. Overall delays in surgical care may be external to the general surgery unit, or before the patient is made known to the surgical team. Analysis of time to surgical review is a key statistic in the delivery of acute surgical care.

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The acute surgical unit: An updated systematic review and meta-analysis

Cited by 10 publications

References 74 publications

Rare causes of abdominal pain: a primer for the admitting general surgeon

Rare causes of abdominal pain: a primer for the admitting general surgeon

Inefficient Admissions for Abdominal Pain Under an Acute General Surgical Unit

Time to acute general surgical review: a retrospective study in a tertiary referral centre

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