AB138. Emergency surgical ambulatory care

Background: The Emergency Surgical Ambulatory Unit at Our Lady’s Hospital Navan accepts unscheduled and undifferentiated referrals from its Emergency Department on a 24/7 basis. In order to deliver appropriate care in the absence of in patient beds, the unit is supported by a virtual ward, hot clinics and a five hospital inpatient transfer policy.

Methods: We present our activity over a 30-month period. The data was collected prospectively being presented and validated at the unit’s twice weekly emergency surgical care dry rounds.

Results: There were a total of 5,431 referrals to the unit. All patients underwent triage, clinical assessment and preliminary investigations. A significant proportion, 57% (3,073) underwent imaging to include ultrasonography and/or Computerised Tomography. One in four patients, 24% (1,329) required inpatient hospital transfer with 24% of these (315) requiring surgical intervention. Of the 4,102 patients that did not require admission, 2,540 were followed up in a virtual ward, hot clinic, endoscopy unit or standard outpatient follow up with 1,496 patients discharged to primary care. Sixty-six patients discharged themselves against medical advice.

Conclusions: The majority of emergency surgical referrals, 76% (4,102) were managed and followed up locally relieving the Emergency Departments and Surgical Units of level IV Hospitals of a considerable clinical load. With the development of a short stay surgical observation unit this proportion could possibly reach 90% as only 6% of our total cohort required surgical intervention.

Keywords: Care; ambulatory; surgical; emergency; Navan