Waiting for definitive care: An analysis of elapsed time from decision to surgery or transfer in a rural centre.
OBJECTIVE
To examine the timing of operative management and interhospital transfer of emergency general surgical patients in a regional setting.


METHODS
Retrospective cohort study.


METHODS
The surgical unit at a major rural referral centre for North-Eastern Victoria servicing a population of 90 000.


METHODS
General surgical patients (n = 649) admitted via the emergency department at Northeast Health Wangaratta between January 2011 and March 2013 undergoing operative management (n = 608) or transfer to a tertiary centre (n = 44).


METHODS
Timing of operative management, using appendicectomy as a benchmark operation, was measured as time from presentation to decision to operate, time from decision to surgery, percentage after-hours operating and length of stay (LOS). Time to interhospital transfer was calculated and reasons for delay were sought.


RESULTS
Two hundred forty-six appendicectomies were performed. Median time from decision to operate to theatre was 3 hours (interquartile range (IQR) 2-8), and total LOS was 43 hours (IQR: 28-56). Two hundred seventy-two procedures (43%) were performed out-of-hours, including 48% of appendicectomies. Median time from decision making to transfer was 10.3 hours (IQR: 4.7-25). Transfer was less likely to be delayed in trauma patients when compared with urgent non-trauma patients (5.3 versus 10.6 hours; P = 0.04).


CONCLUSIONS
Even in the absence of a strict four-hour rule program and a dedicated emergency surgical unit, main outcome measures appear to be comparatively efficient. However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non-trauma transfer from rural centres and bed availability in tertiary hospitals.
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Hannah
H
Dobson
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Weranja K B
WK
Ranasinghe
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Matthew K H
MK
Hong
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Liliana N
LN
Bray
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Manivannan
M
Sathveegarajah
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
Fatima
F
Vally
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.|Rural Health Academic Centre, Melbourne University, Melbourne, Victoria, Australia.
Francis J
FJ
Miller
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation; D012189:Retrospective Studies; D019035:Rural Health Services; D013514:Surgical Procedures, Operative; D014193:Trauma Centers; D014739:Victoria; D014850:Waiting Lists
acute care surgery; emergency surgery; patient transfer; rural health service