title: The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis.
abstract: OBJECTIVE
  To determine whether the introduction of an acute surgical unit (ASU) resulted in a greater proportion of patients with acute cholecystitis receiving definitive surgery on index admission with no adverse change in surgical outcomes.
  
  
  METHODS
  A retrospective study of medical records for patients presenting to Nepean Hospital with acute cholecystitis during the 2 years before and 2 years after introduction of an ASU in November 2006.
  
  
  METHODS
  Time to diagnosis, timing of surgical intervention, surgical outcomes, duration of total admission and complication rates.
  
  
  RESULTS
  A total 271 patients were included in the study (114 pre-ASU, 157 post-ASU). After introduction of the ASU, a higher proportion of patients had surgery on index admission (89.8% v 55.3%; P < 0.001) and there were decreases in median time to diagnosis (14.9 h v 10.8 h; P = 0.008), median time to definitive procedure (5.6 days v 2.1 days; P < 0.001), median duration of total admission (4.9 days v 4.0 days; P = 0.002), rate of intraoperative conversion to open surgery (14.9% v 4.5%; P = 0.003) and rate of postoperative infection (3.5% v 2.5%; P = 0.40).
  
  
  CONCLUSIONS
  Introduction of the ASU at Nepean Hospital resulted in significant improvements in care and outcomes for patients with acute cholecystitis.
authors.affiliation: Royal Prince Alfred Hospital, Sydney, NSW, Australia. guy.eslick@sydney.edu.au.
authors.forename: Lester
authors.initials: L
authors.lastname: Pepingco
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cox
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology; D015397:Program Evaluation; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration* / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult