title: Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice.
abstract: BACKGROUND
  Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary.
  
  
  OBJECTIVE
  In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services.
  
  
  METHODS
  An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention.
  
  
  RESULTS
  1466 patients were admitted as emergencies during the study period. 58 % (850) were male and median age was 48 years (0-100). Average length of stay was 5 days (range 1-125). 327 patients (22.3 %) required operative intervention. The most commonly performed procedure was appendicectomy (52.5 %). 48 (3.3 %) patients were transferred to other hospitals. 131 (8.9 %) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound.
  
  
  CONCLUSIONS
  Almost 80 % of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland. heaneyr@tcd.ie.
authors.forename: R M
authors.initials: RM
authors.lastname: Heaney
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
authors.forename: I
authors.initials: I
authors.lastname: Reynolds
authors.affiliation: Department of Radiology, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
authors.forename: R S
authors.initials: RS
authors.lastname: Ryan
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
authors.forename: I
authors.initials: I
authors.lastname: Khan
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
authors.forename: W
authors.initials: W
authors.lastname: Khan
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Waldron
authors.affiliation: Department of Surgery, Mayo University Hospital, Castlebar, Co. Mayo, Ireland.|Discipline of Surgery, National University of Ireland Galway, Co. Galway, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Barry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011871:Radiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D016526:Workload; D055815:Young Adult
keywords: Admissions; Emergency; Non-operative; Practice implications