title: Evaluation of level 1 care facilities for vascular patients.
abstract: BACKGROUND
  A surgical acute care unit (SACU) was established within our hospital to specifically provide level 1 care to surgical patients. We assess the impact that this has had on outcome in vascular patients.
  
  
  METHODS
  All patients undergoing carotid endarterectomy (CEA) and elective abdominal aortic aneurysm repair (AAA) during the first year of SACU were included in the present study. A control group was compiled from patients undergoing the same two procedures in the year preceding the opening of the SACU. Data were collected on admission time, time spent in critical care, outcome and operative cancellations.
  
  
  RESULTS
  During the first year of the SACU there were 28 CEA and 42 AAA repairs performed. In the control group there were 18 CEA and 34 AAA repairs performed. There were no significant differences in death rate or length of hospital stay between the two groups for either AAA repair or CEA. CEA patients in the study group had a significantly reduced level 2 stay (P < 0.001 Mann-Whitney U-test), with 71% of patients being admitted directly to the level 1 facility from theatre. There were less CEA cancelled because of critical care bed shortages among the cases (n = 0) compared to the control group (n = 2), although this did not reach statistical significance (P = 0.15 Fisher's exact test).
  
  
  CONCLUSIONS
  Designated level 1 care has reduced the need for the postoperative admission of CEA patients to level 2 care facilities. It has had no discernible impact on admission time or mortality, but might reduce the number of cancelled operations caused by a lack of level 2 beds.
authors.affiliation: Department of Surgery, Leicester General Hospital, and University of Leicester, Leicester, England, UK. drmikenorwood@hotmail.com
authors.forename: Michael G A
authors.initials: MG
authors.lastname: Norwood
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bown
authors.forename: Peter R F
authors.initials: PR
authors.lastname: Bell
authors.forename: Paul
authors.initials: P
authors.lastname: Spiers
authors.forename: Apsara
authors.initials: A
authors.lastname: Leslie
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sayers
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001509:Bed Occupancy; D016894:Endarterectomy, Carotid; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010359:Patient Readmission; D011446:Prospective Studies; D018709:Statistics, Nonparametric