285 Trends in Emergency General Surgery activity in a dedicated unit: impact of a 5-consultant EGS team over a 3-year period
Richard Guy, Suzy Smallwood, Antonio Gallucci, Rafik Ishak, Katherine Buckley, Andreas Pilavas- Surgery
Abstract
Aims
A 5-Consultant EGS team was established for all acute General Surgery admissions to a 900-bed DGH. The aim was to evaluate management, outcomes and trends over a period of almost 4 years, incorporating the COVID-19 pandemic period.
Methods
Data was collected prospectively between 01/04/2019 & 09/01/2023 and included number and source of admissions, admission decision, surgery rates and lengths of stay. Three separate time periods were compared: (A) an 11-month pre-pandemic period (B) the official pandemic lockdown period (Mar 2020-Dec 2021) (C) a 12-month post-pandemic period.
Results
Direct GP-to-Consultant telephone referral was mandatory from the start of Period B, with around 200 calls/month, resulting in significant reductions in admission rates. Median weekly admissions for Periods A, B & C were 158, 127 & 132, respectively. Corresponding mean proportions coming from Primary Care vs Emergency Department were 55% vs 31.5%, 38.1% vs 46% & 39.9 vs 41%, respectively. Data since 06/12/2021 shows that 61.6% of admissions were seen by an EGS Consultant within 4 hours. The mean proportions of patients undergoing surgery during the three periods were 19.8%, 18% and 19.2%, respectively. Median length of stay (data available after Mar 2022) was 5 days.
Conclusions
A dedicated Consultant-led EGS service with GP collaboration is associated with improved efficiency, a reduction in GP admission rates, short hospital stays and greater use of ambulatory care. Despite fewer pandemic admissions, there was no significant change in the proportion requiring surgery, reflecting appropriateness of patient selection. Regular data analysis allows service modification responsive to needs.