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Surgical Ambulatory Emergency Care
Case Study – Craigavon Area
Hospital
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Ambulatory Care Craigavon Emergency Surgical ServiceACCESS
Susan Yoong Consultant General Surgeon
Craigavon Area Hospital
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The Challenge
Lack of bed availability
Cancelled operations
Prolonged inpatient wait for investigations,
theatre
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The Aim
To develop a new model to provide safe and
efficient patient care whilst avoiding unnecessary
admissions, promote decreased length of stay
and improve patient experience
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ACCESS
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Then
• 19:00 ED perianal pain
£375
• No space on e list
£375• I+D
abscess 22:00
£375
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Now
• ED 19:00 Perianal pain
Home
• Hot clinic• I+D on EGS list• Home later
-3 bed days
-£1125
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ACCESS
• 12 month period
March 2017– February 2018
• Data capture
ACCESS Diary
NIECR
Theatre Management System
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• 5 DNAs (Excluded)
• 264 patients
• 156 Female
• 108 Male
• Average age 40.1 (14 – 83) yrs
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Results
44%
12%
10%
8%
4%
4%
3%
3%3%
3%2% 1%1%
1%
1% Presenting ComplaintRUQAbscessRIF painHernia/groin painReviewWound problemsAbdominal PainEpigastric painLIF PainSebaceous CystVascularPerianal FistulaPR Bleeding
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ACCESS USS 149/264 (56.4%)
41%
30%
15%
5%
3%3% 2%2%
GallstonesNormalFatty LiverGB PolypsHaemangiomaRenal CystThickened GBGB not seen
118/149(79.2%) for RUQ pain
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0%
25%
50%
75%
100%
ACCESS Patients
Admitted
Outcomes
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ACCESS List
Average Length of Stay = 1.25 dys
EMERGENCY List
Average LOS = 1.69 dys
Operations
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ACCESS LIST ( “Hot List”)
32%
18%
2%
14%
5%
7%
5%
9%
2%2% 2% 2%Procedures
Lap Chole
Lap Appendix
Open Appendix
I+D Abscess
Flexible Sigmoidoscopy
Hernia repair
Inguinal L.N. Bx
EUA anorectum
Excision Seb. Cyst
Deltoid Muscle Bx
Right Hemicolectomy
Reversal of Loop Ilesotomy
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Abscesses
Decreased time to theatre
Decreased Length of stay
Decreased out of hours operating
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SummaryAdmission avoided in 80%
At Least 264 Bed stays saved in 12 months
£375 per Bed stay
= £99,000 / annum
Decreased LOS for ACCESS list
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What Next?
Diagnostics - CT, MRCP
Establish “Virtual List”
Accelerated Discharges
Emergency Surgical Nurse Specialist
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