The Surgical Assessment Unit—Effective Strategy for Improvement of the Emergency Surgical Pathway?

Abstract

A special unit was set up in an associate teaching hospital to provide a fast-track route for the assessment of acute adult surgical and urological referrals. During an audit period of eight weeks, this surgical assessment unit had 550 referrals, of which 196 (36%) came via the accident and emergency (A&E) department; the other 354 came directly from general practitioners or other hospital departments. Mondays, Tuesdays and Fridays were the busiest days of the week; 57% of all patients arrived between 8 am and 5 pm. 68% were seen by a doctor within 1 hour of their arrival. 68% were either discharged or admitted to the main surgical wards within 4 hours. The study showed that, over the course of a year, the surgical assessment unit might divert some 2301 patients away from the A&E department. To achieve this total it would need to be open and appropriately staffed 24 hours a day. Such a unit offers a strategy for limiting the A&E workload and streamlining the assessment of patients with surgical and urological emergencies.

Seasonal variation in emergency referrals to a Surgical Assessment Unit

“…Analysis of the overall number of patients attending SAU during both study periods revealed that the existence of the SAU resulted in the diversion of up to 2540 patients per year away from the A&E department. This figure is comparable with the 2301 patients per year reported in our earlier study (4). It would have been necessary to assess these patients in the A&E department had there not been a fully functioning SAU in our hospital.…”

“…We have previously published a detailed description of the SAU at Medway Maritime Hospital (4) which serves a population of 330,000 people. The unit, which was opened in 2003, provides a fast‐track route for adult (age 16 years and over) emergency surgical and urological referrals, allowing rapid assessment and diagnosis and where appropriate, early access to the operating theatres.…”

“…This, together with the government targets that limit the time that patients should spend in the Accident and Emergency (A&E) department to no more than 4 h, puts enormous strain on staff working in increasingly busy departments. We have previously shown that the establishment of a Surgical Assessment Unit (SAU) can ease the pressure by diverting a significant number of patients away from the A&E department, thereby helping the latter to achieve the waiting time targets (4).…”

Role of an acute assessment and review area for general surgical patients

“…3,4 Surgical and medical admission units in other centres have been reported to reduce all cause mortality, reducing length of stay and diverting a significant number of patients from the ED. 5,6 With this in mind and to overcome the aforementioned issues the department developed the concept of a co-localized dedicated surgical assessment and review area (SARA) within their existing inpatient bed stock. In addition, dedicated medical and nursing staffs were allocated to the unit to ensure optimal patient flow.…”

The clinical need for undergraduate urology

“…Currently in the UK, undergraduate urological exposure is not compulsory, with fewer than half of UK medical schools offering a formal placement with a urological team . Similarly on the international platform, urology has a low priority in the curriculum of medical schools . This is particularly concerning given that urological emergencies account for more than 20 per cent of all acute surgical admissions and 5–10 per cent of general practitioner visits …”