Often the very best innovation comes from the ground up. The Minister continued: “Everyone who has a role in the healthcare delivery process has an important contribution to make in bringing about and influencing change. “This Unit will ensure that there is a clinically safe environment for those patients who may requiring a short period of observation, further investigations or other interventions that cannot be completed within the four hour timeframe within the Emergency Department.” “The ED in Altnagelvin Hospital has seen a 15% increase in attendances compared to the same period last year, many of these are frail elderly patients. This means more people being admitted to hospital resulting in further pressure on the hospital and community system. The Minister said: “This is an excellent additional facility and one that the staff within Altnagelvin Hospital can be rightly proud of as they work exceptionally hard to increase the safe flow of patients across the system. Clinical Governance: An International Journal Emerald Publishing The Minister toured the CDU to see some of the alternatives the staff have developed to reduce pressures in the Emergency Department (ED) and improve patient flow. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. In all, 30-day readmission rates have not been influenced by shorter hospital stay. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). Originality/value – The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p =0.29). Overall there was a 25.3 per cent reduction in emergency surgical admissions. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Findings – More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Statistical analysis using the Mann Whitney U -test was performed. Design/methodology/approach – Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). Purpose – Early access to senior decision makers and investigations has improved outcomes for many conditions. Johnstone, Chris Harwood, Rachel Gilliam, Andrew Mitchell, Andrew A clinical decisions unit improves emergency general surgery care delivery A clinical decisions unit improves emergency general surgery care delivery
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