Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
Eur J Trauma Emerg Surg. 2020 Jun;46(3):627-633. doi: 10.1007/s00068-018-1049-x. Epub 2018 Nov 17.
The traditional 24-h call model faces pressure from competing needs between emergency and elective services. Recognizing this, a dedicated ESAT service was developed in Khoo Teck Puat Hospital in Singapore, with improved clinical outcomes. It was initially led by a single consultant (SC) in 2014, and subsequently evolved to a weekly consultant rotation (WC) roster in 2017 to achieve sustainability.
Each consultant led the ESAT WC service for a week and maintained ownership of their patients thereafter. All emergency surgical admissions between two distinct 6-month periods were reviewed, from May to October 2014 (pre-ESAT) and January to June 2017 (ESAT WC). Patient demographics, diagnoses, and operations were compared. Efficiency and clinical outcomes were evaluated.
There were 1248 and 1284 patients in the pre-ESAT and ESAT WC group, respectively. Majority were males and in their 50s. Acute appendicitis, gallstone conditions, and soft-tissue infections made up half of the admissions. Trauma workload was comparable (7.8% pre-ESAT vs 9.5% ESAT WC). Cholecystectomies doubled during the ESAT period, 14.2% vs 7.2%, (p = 0.01). More consultants were involved in major cases (95.9% vs 86%), (p = 0.01) and more operations were performed during the day (52.1% vs 47.9%), (p = 0.01). Average time to OT was shorter and there were less major surgical complications (p = 0.02). Mortality (p = 0.08) and length of stay were reduced (4 vs 4.5 days), (p = 0.01).
The ESAT WC service has sustained improved outcomes in our institution.
传统的 24 小时呼叫模式面临着急诊和择期服务之间竞争需求的压力。认识到这一点，新加坡 Khoo Teck Puat 医院开发了专门的 ESAT 服务，临床结果得到了改善。该服务最初由一位顾问（SC）于 2014 年领导，随后在 2017 年演变为每周顾问轮班（WC）名单，以实现可持续性。
每位顾问负责 ESAT WC 服务一周，此后负责其患者。审查了两个不同的 6 个月期间的所有急诊手术入院情况，分别是 2014 年 5 月至 10 月（ESAT 前）和 2017 年 1 月至 6 月（ESAT WC）。比较了患者的人口统计学、诊断和手术情况。评估了效率和临床结果。
ESAT 前和 ESAT WC 组分别有 1248 名和 1284 名患者。大多数患者为男性，年龄在 50 多岁。急性阑尾炎、胆石症和软组织感染占入院人数的一半。创伤工作量相当（ESAT 前为 7.8%，ESAT WC 为 9.5%）。胆囊切除术在 ESAT 期间增加了一倍，分别为 14.2%和 7.2%（p=0.01）。更多的顾问参与了大手术（95.9%比 86%）（p=0.01），更多的手术在白天进行（52.1%比 47.9%）（p=0.01）。平均进入手术室时间更短，主要手术并发症更少（p=0.02）。死亡率（p=0.08）和住院时间缩短（分别为 4 天和 4.5 天）（p=0.01）。
ESAT WC 服务在我们机构保持了改善的结果。
