Mathur Sachin, Lim Woan Wui, Goo Tiong Thye
Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore.
Injury. 2018 Jan;49(1):130-134. doi: 10.1016/j.injury.2017.09.002. Epub 2017 Sep 5.
There is a significant burden on public health systems from emergency surgical and trauma (ESAT) patients. In Western countries, the response has been to separate acute and elective surgery with the creation of a new sub-specialty: acute care surgery. Dedicated acute units have shown improvements in efficiency and clinical outcomes for patients. The aim of this study was to assess the results of the first such unit in Singapore.
A retrospective analysis was performed of a 12-month period of acute admissions between May 2014 and April 2015, with comparison of 6-months before and after the creation of the ESAT service. The ESAT service was a consultant led dedicated team managing all daily acute and trauma patients. Demographic, efficiency and clinical outcome key performance indicators were compared.
There were 2527 acute admissions split between the two time periods. The ESAT service (N=1279) managed soft tissue infections (257, 20%), appendicitis (199, 16%) and biliary disease (175, 14%) most commonly. The most common of the 573 procedures performed were incision and drainage (242, 42%), appendicectomy (188, 33%) and laparotomy (84, 16%). Clinical outcome during the ESAT service included reduction in overall mean length of stay (4.5d to 3.5d, P<0.01) and mortality (24/1248 (1.9%) to 11/1279 (0.9%), P=0.03). Efficiency gains in theatre booking time, ED surgical review and overall costs were also noted.
The creation of an ESAT service has led to improved efficiency of care with no worsening of clinical outcomes for acute general surgical and trauma patients.
急诊外科和创伤（ESAT）患者给公共卫生系统带来了沉重负担。在西方国家，应对措施是通过创建一个新的亚专业——急性护理外科，将急性手术和择期手术分开。专门的急性护理单元已显示出可提高患者的治疗效率和临床结局。本研究的目的是评估新加坡首个此类单元的效果。
对2014年5月至2015年4月期间12个月的急性入院病例进行回顾性分析，并比较ESAT服务创建前后6个月的情况。ESAT服务由顾问领导一个专门团队，负责管理所有日常急性和创伤患者。比较了人口统计学、效率和临床结局等关键绩效指标。
两个时间段共有2527例急性入院病例。ESAT服务组（N = 1279）最常处理的是软组织感染（257例，20%）、阑尾炎（199例，16%）和胆道疾病（175例，14%）。在进行的573例手术中，最常见的是切开引流（242例，42%）、阑尾切除术（188例，33%）和剖腹术（84例，16%）。ESAT服务期间的临床结局包括总体平均住院时间缩短（从4.5天降至3.5天，P < 0.01）和死亡率降低（从1248例中的24例（1.9%）降至1279例中的11例（0.9%），P = 0.03）。还注意到手术安排时间、急诊科手术评估和总体成本方面的效率提升。
ESAT服务的创建提高了急性普通外科和创伤患者的护理效率，且临床结局未恶化。
