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Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice

Abstract

Background

Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary.

Aims

In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services.

Methods

An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention.

Results

1466 patients were admitted as emergencies during the study period. 58 % (850) were male and median age was 48 years (0-100). Average length of stay was 5 days (range 1–125). 327 patients (22.3 %) required operative intervention. The most commonly performed procedure was appendicectomy (52.5 %). 48 (3.3 %) patients were transferred to other hospitals. 131 (8.9 %) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound.

Conclusion

Almost 80 % of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.

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Correspondence to R. M. Heaney.

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Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Heaney, R.M., Reynolds, I., Ryan, R.S. et al. Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice. Ir J Med Sci 186, 219–224 (2017). https://doi.org/10.1007/s11845-016-1496-5

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  • DOI: https://doi.org/10.1007/s11845-016-1496-5

Keywords

  • Non-operative
  • Emergency
  • Admissions
  • Practice implications