The acute surgical unit: improving emergency care.
BACKGROUND
Acute care surgical teams are a new concept in the provision of emergency general surgery. Juggling emergency patients around the surgeons' and staffs' elective commitments resulted in semi-emergency procedures routinely being delayed. In an era of increasing financial pressure and the recent introduction of 'safe work hours' practices, the need for a new system which optimized available resources became apparent.


METHODS
At Fremantle Hospital we developed a new system in a concerted effort to minimize the waiting time for general surgical referrals in the Emergency Department, as well as to move semi-urgent operating from the afterhours to the daytime. To analyse the impact of the ASU, data were collected during February, March, and April 2009 and compared with data from the same period in 2008.


RESULTS
Although most referrals were received afterhours, over 85% of operations were performed during working hours compared with 72% in the 2008 period. The time from referral to review decreased from an average of 3.2 h in 2008 to 2.1 h. The mean duration of stay in 2009 was 3 days, which was a reduction from 4.2 days in 2008. An increase in weekend discharge rates was seen after the introduction of the ASU.


CONCLUSIONS
Despite an increased workload, more referrals were seen and more operations performed during working hours and the time from referral to review was reduced. Higher discharge rates and reduced length of stays increased the availability of beds. We have demonstrated a successful new model which continues to evolve.
Department of General Surgery, Fremantle Hospital, WA, Australia. doravonconrady@gmail.com
Dora
D
Von Conrady
Saud
S
Hamza
Dieter
D
Weber
Koorush
K
Kalani
Krishna
K
Epari
Marina
M
Wallace
David
D
Fletcher
D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D012017:Referral and Consultation / Q000458:organization & administration*; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D013997:Time Factors; D016526:Workload