AB148. SOH21AS102. Do surgical discharges from the emergency department receive the intended follow up?

Background: General surgical review of patients presenting to the Emergency Department (ED) results in one key clinical decision: should this patient be admitted or discharged. Of the patients surgically discharged, a proportion will have a follow up plan comprising an outpatient (OPD) appointment, imaging or endoscopy. Failure of this follow up to occur results in missed opportunities for patient review, impacting both patient safety and satisfaction. The internal standard we aim for is 95% patients receiving follow up as planned upon discharge from ED. The goal of this audit was to review the current practice for arranging surgical follow up.

Methods: Patients presenting to the ED from 1/7/20 to 1/10/20, referred to General Surgery and then discharged without admission were audited. Data collection included surgical sign out documentation, electronic patient records, and the local patient booking system.

Results: Eighty-nine patients were surgically reviewed and subsequently discharged from the ED, with 63% of these having documented follow up stated in the surgical sign out. 20% patients were assigned multi-modality follow up. 87% OPD appointments, 100% imaging and 75% endoscopic investigations were appropriately booked. Of these, 88% OPD appointments, 15% imaging and 77% endoscopies were carried out.

Conclusions: To achieve follow up occurrence rates of 95%, we have created a set of guidelines to standardise the arrangement of follow up planning for patients who are surgically discharged from the ED. We also recommend that all patients in this cohort receive an OPD appointment, in person or virtual. We will re-audit in a 3-month cycle post implementation to assess potential system improvement and determine the sustainability of same.

Keywords: Discharge; emergency; follow up; general surgery; surgical review