Abstract
Background
The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia.
Methods
A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients.
Results
Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay.
Conclusions
This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.
Similar content being viewed by others
References
Hoyt DB, Kim HD, Barrios C (2008) Acute care surgery: a new training and practice model in the United States. World J Surg 32:1630–1635
Uranues S, Lamont E (2008) Acute care surgery: the European model. World J Surg 32:1605–1612
Britt RC, Weireter LJ, Britt LD (2009) Initial implementation of an acute care surgery model: implications for timeliness of care. J Am Coll Surg 209:421–424
Cox MR, Cook L, Dobson J et al (2010) Acute Surgical Unit: a new model of care. ANZ J Surg 80:419–424
Parasyn AD, Truskett PG, Bennett M et al (2009) Acute-care surgical service: a change in culture. ANZ J Surg 79:12–18
Von Conrady D, Hamza S, Weber D et al (2010) The Acute Surgical Unit: improving emergency care. ANZ J Surg 80:933–936
Semmens JB, Aitken RJ, Sanfilippo FM et al (2005) The Western Australian audit of surgical mortality: advancing surgical accountability. Med J Aust 183:504–508
New South Wales Department of Health (2009) Emergency surgery guidelines. GL2009_009 edn. NSW Department of Health. http://www0.health.nsw.gov.au/policies/gl/2009/GL2009_009.html/. Accessed 23 June 2013
Poole GH, Glyn T, Srinivasa S et al (2012) Modular acute system for general surgery: hand over the operation, not the patient. ANZ J Surg 82:156–160
General Surgeons Australia (2013) 12 Point Plan for Emergency General Surgery. http://www.generalsurgeons.com.au/media/files/News/PRP%20201011-16%2012%20Point%20Plan%20-%20Lo%20Res.pdf. Accessed 30 March 2013
Royal Australasian College of Surgeons (2011) The case for the separation of elective and emergency surgery. http://www.surgeons.org/media/307115/sbm_2011-05-24_separating_elective_and_emergency_surgery.pdf/. Accessed 30 March 2013
Earley AS, Pryor JP, Kim PK et al (2006) An acute care surgery model improves outcomes in patients with appendicitis. Ann Surg 244:498–504
Gandy RC, Truskett PG, Wong SW et al (2010) Outcomes of appendectomy in an acute care surgery model. Med J Aust 193:281–284
Hsee L, Devaud M, Civil I (2012) Key performance indicators in an acute surgical unit: have we made an impact? World J Surg 36:2335–2340
Cubas RF, Gomez NR, Rodriguez S et al (2012) Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost. J Am Coll Surg 215:715–721
Simpson J, Samaraweera AP, Sara RK et al (2008) Acute appendicitis: a benign disease? Ann R Coll Surg Engl 90:313–316
Chandrasegaram MD, Rothwell LA, An EI et al (2012) Pathologies of the appendix: a 10-year review of 4670 appendectomy specimens. ANZ J Surg 82:844–847
Ekeh AP, Monson B, Wozniak CJ et al (2008) Management of acute appendicitis by an acute care surgery service: is operative intervention timely? J Am Coll Surg 207:43–48
Grantcharov TP, Bardram L, Funch-Jensen P et al (2001) Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ 323:1222–1223
Taffinder NJ, McManus IC, Gul Y et al (1998) Effect of sleep deprivation on surgeons’ dexterity on laparoscopy simulator. Lancet 352:1191
Pepingco L, Eslick GD, Cox MR (2012) The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis. Med J Aust 196:509–510
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lancashire, J.F., Steele, M., Parker, D. et al. Introduction of an Acute Surgical Unit: Comparison of Performance Indicators and Outcomes for Operative Management of Acute Appendicitis. World J Surg 38, 1947–1953 (2014). https://doi.org/10.1007/s00268-014-2497-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2497-z