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Research
Emergency general surgery ‘Hot Clinics’ reduce admission rates and duration of inpatient stay
  1. Francesca Th'ng1,
  2. Christos Skouras1,
  3. Alice Paterson-Brown2,
  4. Rajan Ravindran3,
  5. Peter Lamb3,
  6. Andrew de Beaux3,
  7. Simon Paterson-Brown3,
  8. Damian J Mole1,3
  9. on behalf of the Edinburgh Emergency Surgery Study Group
    1. 1Department of Clinical Surgery, School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, UK
    2. 2St George's School, Edinburgh, UK
    3. 3General Surgery Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
    1. Correspondence to Francesca Th'ng, Department of Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; fcsthng1{at}doctors.org.uk

    Abstract

    Objective To determine the impact of a ‘Hot Clinic’ (HC) on emergency general surgery patient flow-through.

    Design Prospective service evaluation study.

    Setting HC is a four-bedded area coordinated by a specialist nurse. The HC consultant sees emergency patients referred from the emergency department, general practitioners or those in preceding 24 h considered suitable for interim discharge while awaiting investigations and HC reassessment.

    Patients All patients with acute abdominal pain were evaluated in three 4 week groups: before (group 1), 1 month (group 2) and 6 months after the HC was introduced (group 3). Interhospital transfers, intrahospital ward referrals and trauma patients were excluded.

    Intervention Introduction of consultant-led surgical HC every weekday afternoon.

    Main outcome measures Proportion of patients admitted under general surgeons, length of inpatient stay and the proportion of patients referred again within 3 months were investigated.

    Results 1409 patients were referred, of which 1061 met the inclusion criteria: 307 in group 1, 326 in group 2 and 428 in group 3. There was no difference in gender distribution (p=0.759). Inpatient admissions were significantly reduced (85.0% vs 78.2% vs 54.4%; p<0.001) and the inpatient duration of stay was significantly shorter after HC introduction (median (IQR) (95% CI) 63.8 (29.0–111.6) (51.8 to 72.8) hours vs 48.8 (21.7–101.2) (42.0 to 55.6) hours vs 47.7 (20.9–92.7) (42.8 to 56.9) hours; p=0.011).

    Conclusions Emergency general surgery HCs are associated with significant reductions in admission rates and inpatient bed occupancy. This service redesign has the potential to dramatically relieve pressure on acute surgical services.

    • ABDOMINAL PAIN
    • HEALTH SERVICE RESEARCH
    • MEDICAL STATISTICS
    • HEALTH ECONOMICS

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