Cutting the cost of emergency surgical admissions.

Over a one-month period, 207 general surgical emergency admissions (excluding urology) to a district general hospital were audited. The potential to improve the delivery of emergency care and reduce inpatient stay was studied. During the year of study, 44 per cent of all surgical admissions were emergency patients who consumed 61 per cent of inpatient bed days. Most emergency admissions were for gastroenterological problems although patients with arterial disorders tended to have relatively prolonged inpatient stays. Operations were performed in 34 per cent of emergency admissions with six post-operative deaths. Delays in operative treatment were mainly due to waiting for space on scheduled operating lists. A number of post-operative patients remained in hospital over the weekend awaiting discharge on Monday. Most emergency admissions were treated conservatively. Delays in discharge of fit patients occurred whilst the results of inpatient investigations were awaited. Twelve patients were admitted for complications of previous procedures. Emergency patients accounted for over half the inpatient bed days. There is considerable scope for improving the process of delivery of emergency surgical care and reducing inpatient stay.