title: Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.
abstract: A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester,  UK.
authors.forename: Muhammad I
authors.initials: MI
authors.lastname: Aslam
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: Apostolos
authors.initials: A
authors.lastname: Nakas
authors.forename: David A
authors.initials: DA
authors.lastname: Waller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003142:Communication; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D017598:Efficiency, Organizational; D004630:Emergencies; D004739:England; D005260:Female; D006767:Hospitals, District / Q000458:organization & administration*; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D018579:Patient Selection; D010360:Patient Transfer / Q000458:organization & administration*; D011030:Pneumothorax / Q000601:surgery*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult