title: The impact of a surgical assessment unit on numbers of general surgery outliers.
abstract: OBJECTIVE
  Patient care and efficiency outcomes are improved if acute patients admitted to non-specialty (outlier) wards are minimised.1 Assessment units may help to reduce numbers of outlier patients.2 A surgical assessment unit (SAU) was recently established at Middlemore Hospital. We aimed to determine the impact of its introduction on numbers of general surgery outliers on post-acute ward rounds.
  
  
  METHODS
  A 10-bed SAU was introduced in July 2015, coinciding with the closure of 20 beds on the general surgical wards. The numbers and locations of patients on post-acute ward rounds before and after the establishment of the SAU were compared. A student two-tailed t-test was used for statistical comparisons, with p<0.05 considered significant.
  
  
  RESULTS
  A total of 1,462 patient locations were analysed from 71 post-acute ward rounds. There were similar overall numbers of post-acute patients before and after the introduction of the SAU (mean 21 vs 20, p=0.33). There were fewer post-acute patients in outlier wards after the introduction of the SAU (mean 1.7 before vs 0.8 after, p=0.04).
  
  
  CONCLUSIONS
  Despite a net reduction in general surgery beds and no change in the overall number of post-acute patients, the establishment of a SAU was associated with a reduction in outliers.
authors.affiliation: General Surgery Registrar, Auckland City Hospital, Auckland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jacobson
authors.affiliation: General Surgeon, Department of General Surgery, Middlemore Hospital, Auckland.
authors.forename: Garth
authors.initials: G
authors.lastname: Poole
authors.affiliation: General Surgeon, Department of General Surgery, Middlemore Hospital, Professor of Surgery, University of Auckland, Auckland.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.affiliation: General Surgeon, Department of General Surgery, Middlemore Hospital, Auckland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Biggar
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005500:Follow-Up Studies; D006801:Humans; D017060:Patient Satisfaction; D011369:Professional-Patient Relations / Q000941:ethics*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment