SP3.1.10 Surgical Emergency Assessment Unit and Emergency Surgeon of the Week’ : A Paradigm shift to providing Emergency Surgical Care

Abstract Aims Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system. Patients and Method Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team. Results SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others. Conclusions A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.

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Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211006692 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110066

Author(s):

Naoko Onizuka ◽

Lauren N. Topor ◽

Lisa K. Schroder ◽

Julie A. Switzer

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Healthcare System ◽

Perioperative Complications ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Surgical Care ◽

Admission Rate ◽

System Response ◽

Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

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Predicting Inpatient Detoxification Outcome of Alcohol and Drug Dependent Patients: The Influence of Sociodemographic Environment, Motivation, Impulsivity, and Medical Comorbidities

Journal of Addiction ◽

10.1155/2017/6415831 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 11

Author(s):

Yvonne Sofin ◽

Heidi Danker-Hopfe ◽

Tina Gooren ◽

Peter Neu

Keyword(s):

Treatment Outcome ◽

Social Environment ◽

Negative Impact ◽

Emergency Admission ◽

Positive Outcome ◽

Current Treatment ◽

The Impact ◽

Drug And Alcohol ◽

Drop Outs ◽

Alcohol Dependent

Aims. This prospective study aims to identify patient characteristics as predictors for treatment outcome during inpatient detoxification treatment for drug and alcohol dependent patients.Methods. A mixed gender sample of 832 consecutively admitted drug and alcohol dependent patients were interviewed by an experienced physician. The impact of a variety of factors concerning social environment, therapy motivation, impulsivity related variables, medical history, and addiction severity on treatment outcome was examined.Results. 525 (63.1%) of the patients completed detoxification treatment whereas 307 (36.9%) dropped out prematurely. Being female, living in a partnership, having children, being employed, and having good education were predictive for a positive outcome. Family, health, the fear of losing the job, prosecution, and emergency admission were significant motivational predictors for treatment outcome. Being younger, history of imprisonment, and the number of previous drop-outs were predictive for a negative outcome.Conclusions. Variables concerning social environment and the number of previous drop-outs have been identified as best predictors for treatment outcome. Socially stable patients benefit from the current treatment setting and treatment shall be adapted for patients with negative predictors. Treatment may consequently be tailored with respect to intervention type, duration, and intensity to improve the outcome for those patients that fulfil criteria with negative impact on treatment retention.

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Can a perioperative physician improve care and reduce length of stay in a surgical emergency admission unit?

Clinical Medicine ◽

10.7861/clinmedicine.15-3-s22 ◽

2015 ◽

Vol 15 (Suppl 3) ◽

pp. s22-s22

Author(s):

Margaret Hammersley ◽

Hywel Jones ◽

Sudhir Singh ◽

Irene Stratton ◽

Michael Silva

Keyword(s):

Length Of Stay ◽

Emergency Admission ◽

Surgical Emergency

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Unplanned readmissions in ENT

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363514x14042954768475 ◽

2014 ◽

Vol 96 (8) ◽

pp. 268-269 ◽

Cited By ~ 1

Author(s):

M Rashid ◽

H Khalil

Keyword(s):

Admission Rate ◽

Emergency Admission ◽

Day Case ◽

Readmission Rates ◽

Emergency Admissions ◽

Short Notice ◽

Hospital Beds ◽

Bed Days ◽

The Uk

Emergency admissions have been defined as those that are not predicted and happen at short notice because of perceived clinical need. 1 Although far from a UK-only problem, in 2007–2008 approximately 65% of hospital beds in England were for emergencies (equivalent to 34 million bed days and 4.75 million emergency admissions). 2 The number of day-case procedures being performed in the UK is increasing steadily in keeping with government targets but unless readmission rates are addressed, this can only exacerbate the burgeoning emergency admission rate.

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Deprivation influences the emergency admission rate of ambulatory care sensitive conditions

Clinical Medicine ◽

10.7861/clinmedicine.16-2-119 ◽

2016 ◽

Vol 16 (2) ◽

pp. 119-123 ◽

Cited By ~ 6

Author(s):

Richard Conway ◽

Deirdre O’Riordan ◽

Declan Byrne ◽

Sean Cournane ◽

Seamus Coveney ◽

...

Keyword(s):

Ambulatory Care ◽

Admission Rate ◽

Emergency Admission ◽

Ambulatory Care Sensitive Conditions ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

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LO92: Development of a predictive model for hospital admissions by utilizing frequencies of specific CEDIS presenting complaints

CJEM ◽

10.1017/cem.2018.154 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S40-S40

Author(s):

D. Lewis ◽

G. Stoica ◽

J. P. French ◽

P. Atkinson

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Hospital Admissions ◽

Admission Rate ◽

Emergency Admission ◽

Altered Level ◽

Admission Rates ◽

Likelihood Model ◽

Predictive Strength

Introduction: With hospital occupancy rates frequently approaching 100%, even small variations in daily admission numbers can have a large impact. The ability to predict variance in emergency admission rates would provide administrators with a significant advantage in managing hospital daily bed requirements. There is a growing interest in patterns of hospital admissions, and many EDs utilize historical admission patterns to attempt to predict daily bed requirements. Previous studies have utilized patient demographics and past medical history to develop an admission likelihood model. We wished to examine the predictive strength of individual CEDIS presenting complaints (PC) on admission likelihood Methods: Using a database analysis of over 285,000 ED presentations (2013-2017), we calculated visit frequencies and admission rates by PC. Using a logistic regression analysis PCs were ordered from high to medium predictive strength. Results: Of 285,155 presentations, there were 38,090 hospital admissions, a rate of 13.36%. Based on the number of visit frequencies and admission rates, the PCs demonstrating high predictive strength were Direct Referral (effect=0.36, binomial CI: 0.28 to 0.44); Shortness of Breath (0.32: 0.26 to 0.41); General Weakness; Weakness/Query CVA; & Chest Pain Cardiac Features (each 0.30: 0.25 to 0.42); Altered level of consciousness (0.24: 0.16 to 0.31); and Confusion (0.18: 0.08 to 0.26). With our sample size, all remaining CEDIS PCs had low predictive value (the effect is <0.1), or were not predictive at all. Conclusion: We have demonstrated that, for our population, certain PCs are associated with an increased likelihood of admission and have quantified this effect using logistic regression analysis. Variance from the average daily admission rate may be predicted, in our population, by identifying these PCs at registration.We plan to develop a tool, based on this data and implemented at registration, to predict cumulative likely daily admission requirements as patients present over a 24hr period.

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The Gujarat Earthquake (2001) Experience in a Seismically Unprepared Area: Community Hospital Medical Response

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00000947 ◽

2002 ◽

Vol 17 (4) ◽

pp. 186-195 ◽

Cited By ~ 10

Author(s):

Nobhojit Roy ◽

Hemant Shah ◽

Vikas Patel ◽

R. Richard Coughlin

Keyword(s):

Tertiary Care ◽

Family Members ◽

Health Resources ◽

Admission Rate ◽

Buffer Zone ◽

Definitive Treatment ◽

Traditional Architecture ◽

Hospital Admission Rate ◽

Medical Response ◽

Better Than

AbstractBackground:At 08:53 hours on 26 January 2001, an earthquake measuring 6.9 on the Richter scale devastated a large, drought-affected area of northwestern India, the state of Gujarat. The known number killed by the earthquake is 20,005, with 166,000 injured, of whom 20,717 were “seriously” injured. About 370,000 houses were destroyed, and another 922,000 were damaged.Methods:A community health worker using the local language interviewed all of the patients admitted to the Gandhi-Lincoln hospital with an on-site, oral, real-time, Victim Specific Questionnaire (VSQ).ResultsThe census showed a predominance of women, children, and young adults, with the average age being 28 years. The majority of the patients had other family members who were also injured (84%), but most had not experienced deaths among family members (86%). Most of the patients (91%) had traveled more than 200 kilometers using their family cars, pick-ups, trucks, or buses to reach the buffer zone hospitals. The daily hospital admission rate returned to pre-event levels five days after the event, and all of the hospital services were restored by nine days after the quake. Most of the patients (83%) received definitive treatment in the buffer zone hospitals; 7% were referred to tertiary-care centers; and 9% took discharge against medical advice.The entrapped village folk with their traditional architecture had lesser injuries and a higher rescue rate than did the semi-urban townspeople, who were trapped in collapsed concrete masonry buildings and narrow alleys. However, at the time of crisis, aware townspeople were able to tap the available health resources better than were the poor. There was a low incidence of crush injuries. Volunteer doctors from various backgrounds teamed up to meet the medical crisis. International relief agencies working through local groups were more effective. Local relief groups needed to coordinate better. Disaster tourism by various well-meaning agencies took a toll on the providers. Many surgeries may have contributed to subsequent morbidity.Conclusions:The injury profile was similar to that reported for most other daytime earthquakes. Buffer zone treatment outcomes were better than were the field and damaged hospital outcomes.

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The Gujarat Earthquake (2001) Experience in a Seismically Unprepared Area: Community Hospital Medical Response

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00000480 ◽

2002 ◽

Vol 17 (4) ◽

pp. 186-195 ◽

Cited By ~ 39

Author(s):

Nobhojit Roy ◽

Hemant Shah ◽

Vikas Patel ◽

R. Richard Coughlin

Keyword(s):

Tertiary Care ◽

Family Members ◽

Health Resources ◽

Admission Rate ◽

Buffer Zone ◽

Definitive Treatment ◽

Traditional Architecture ◽

Hospital Admission Rate ◽

Medical Response ◽

Better Than

AbstractBackground:At 08:53 hours on 26 January 2001, an earthquake measuring 6.9 on the Richter scale devastated a large, drought-affected area of northwestern India, the state of Gujarat. The known number killed by the earthquake is 20,005, with 166,000 injured, of whom 20,717 were “seriously” injured. About 370,000 houses were destroyed, and another 922,000 were damaged.Methods:A community health worker using the local language interviewed all of the patients admitted to the Gandhi-Lincoln hospital with an on-site, oral, real-time, Victim Specific Questionnaire (VSQ).Results:The census showed a predominance of women, children, and young adults, with the average age being 28 years. The majority of the patients had other family members who were also injured (84%), but most had not experienced deaths among family members (86%). Most of the patients (91%) had traveled more than 200 kilometers using their family cars, pick-ups, trucks, or buses to reach the buffer zone hospitals. The daily hospital admission rate returned to pre-event levels five days after the event, and all of the hospital services were restored by nine days after the quake. Most of the patients (83%) received definitive treatment in the buffer zone hospitals; 7% were referred to tertiary-care centers; and 9% took discharge against medical advice.The entrapped village folk with their traditional architecture had lesser injuries and a higher rescue rate than did the semi-urban townspeople, who were trapped in collapsed concrete masonry buildings and narrow alleys. However, at the time of crisis, aware townspeople were able to tap the available health resources better than were the poor. There was a low incidence of crush injuries. Volunteer doctors from various backgrounds teamed up to meet the medical crisis. International relief agencies working through local groups were more effective. Local relief groups needed to coordinate better. Disaster tourism by various well-meaning agencies took a toll on the providers. Many surgeries may have contributed to subsequent morbidity.Conclusions:The injury profile was similar to that reported for most other daytime earthquakes. Buffer zone treatment outcomes were better than were the field and damaged hospital outcomes.

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Hospital Re-Admissions: An Empirical Analysis of Quality Management in Taiwan

Health Services Management Research ◽

10.1177/095148480101400203 ◽

2001 ◽

Vol 14 (2) ◽

pp. 92-103 ◽

Cited By ~ 1

Author(s):

Kai-Li Tsai ◽

Ay-Chen Lee ◽

Patrick Asubonteng Rivers

Keyword(s):

Retrospective Study ◽

Quality Management ◽

Quality Evaluation ◽

Average Length ◽

Admission Rate ◽

Emergency Admission ◽

Patient Characteristics ◽

Insurance Status ◽

Significant Relationships ◽

Level Data

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.

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Effect of the COVID-19 pandemic on complications and mortality of patients with cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01744-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xue Wang ◽

Heng Gao ◽

Zhanqin Zhang ◽

Chao Deng ◽

Yang Yan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Area Under The Curve ◽

Admission Rate ◽

Emergency Admission ◽

Control Group ◽

Short Term ◽

Short Term Mortality ◽

Complications And Mortality

Abstract Objectives The purpose of this study was to assess changes in cardiovascular disease severity, types, postoperative complications and prognosis during the COVID-19 pandemic and to explore possible influencing factors. Methods A total of 422 patients were enrolled in this study, and hospitalization and short-term follow-up data were retained. The patient population included 273 men and 149 women. Patients had a median (IQR) age of 54 (45–62) years and were divided into an observation group (130) and a control group (292), primarily according to severity of disease, disease types, baseline indexes, biochemical indexes, cardiac function indexes, complications and prognosis. Results During the COVID-19 pandemic, compared with the same period last year, there was a significant increase in patients with aortic dissection (27.69% vs 5.82%), a significant decrease in patients with valvular heart disease (43.08% vs 66.78%), and significantly increased emergency admission (50.00% vs 21.23%) and severity (54.62% vs 27.40%). Family company (76.37% vs 64.62%) was decreased, EuroSCORE [6.5 (2–9) vs 2 (0–5)] score, Pro-BNP [857.50 (241.00–2222.50) vs 542.40 (113.45–1776.75)] ng/L, six months mortality rate (18.46% vs 8.90%), and postoperative complications, including infected patients, atelectasis, pulmonary edema, and so on were increased, with longer length of stay in the ICU and hospital in COVID-19 pandemic. Survival analysis curve further demonstrated that it had an impact on the deaths of patients during the COVID-19 pandemic period. Through ROC analysis of the death factors of patients, it was concluded that Family company affected the death of patients, and the area under the curve was 0.654 (P < 0.05). Conclusions In this study, we found that the admission rate of critically ill patients with cardiovascular disease, complications of cardiac surgery, and short-term mortality of patients all exhibited a short-term increase, family company may be a risk factors for short-term mortality, that may be related to public pressure caused by the COVID-19 pandemic.

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