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Emergency general surgery ‘Hot Clinics’ reduce admission rates and duration of inpatient stay
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  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

    https://doi.org/10.1136/flgastro-2015-100634

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      Footnotes

      • Previous communications: International Surgical Congress of the Association of Surgeons of Great Britain and Ireland (ASGBI) 2015, Manchester, UK. Oral presentation as Short Paper on 23rd April 2015. Session: T3C3 General Surgery/Surgical pathways ASGBI Short Papers 12. Presentation unique code 448. Abstract reference: Th'ng F, Skouras C, Lamb P, et al. Impact of Hot Clinic on acute general surgical admissions. BJS 2015;102(Suppl 7):63.

      • Collaborators Members of the Edinburgh Emergency Surgery Study Group (Study Contributors): Graeme Couper, Chris Deans, Gavin GP Browning, Anna M Paisley, Bruce Tulloh, Richard JE Skipworth, Shona Mowitt, Alison Forsyth, Suzanne Crawford, Claire Leavy.

      • Contributors FT: acquired, analysed and interpreted data, drafted and revised paper and approved submitted version of study. C S: analysed data, revised paper and approved submitted version of study. A P-B: designed, acquired and analysed pilot study, interpreted data, revised paper and approved submitted version of study. R R: designed intervention, acquired and analysed pilot study, interpreted data, revised paper and approved submitted version of study. P L: designed study, interpreted data, revised paper and approved submitted version of study. A d B: interpreted data, revised paper and approved submitted version of study. S P-B: suggested the introduction of the HC, designed study, interpreted data, revised paper and approved submitted version of study. D J M: designed study, interpreted data, drafted and revised paper, and approved submitted version of study.

      • Competing interests None declared.

      • Ethics approval South East Scotland Research Ethics Service of National Health Service (NHS) Lothian.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement Patient data used in the study are available on the national electronic archive system—national electronic patient record (TRAK) System, and are available to personnel who have been given authorisation by NHS to access TRAK.