None listed
Conditions
Brief summary
Lay summary When a patient has their appendix removed (appendicectomy), the specimen is then examined under a microscope in a laboratory. Most show an inflamed appendix (appendicitis), as expected, a few are normal (negative), and approximately 10% show important unexpected findings (pathology). These include cancer, pre-cancerous growths (polyps), abnormally located cells from the womb (endometriosis) or parasites. In 2005, a new structure of care for patients with appendicitis and other emergency general surgery (EGS) conditions. Unlike the previous Traditional arrangements, this acute surgical unit (ASU) model allocated separate teams to elective and emergency patients. Many studies have shown that the ASU model reduces the time spent waiting for the operating theatre, the overall time spent in hospital and complications. However, it is unclear whether this dedicated team for EGS patients leads to better care or communication when unexpected findings occur. Therefore, amongst appendicectomy patients with important incidental findings, we aimed to assess whether introducing an ASU led to better surgeon-to-patient and surgeon-to-general practitioner communication, and better management.
Interventions
Introduction of an acute surgical unit model (ASU).
Traditionally, general surgery departments allocated their surgeons and trainees to elective duties. Emergency general surgery (EGS) patients were managed ad-hoc, either after long delays, or through the interruption of elective patients. An alternative ASU model was introduced at our hospital on 01/08/2012. Compared with the Traditional model of managing emergency general surgical referrals, the ASU provides resources solely for EGS patients.
Introduction of an acute surgical unit model (ASU). Traditionally, general surgery departments allocated their surgeons and trainees to elective duties. Emergency general surgery (EGS) patients were managed ad-hoc, either after long delays, or through the interruption of elective patients. An alternative ASU model was introduced at our hospital on 01/08/2012. Compared with the Traditional model of managing emergency general surgical referrals, the ASU provides resources solely for EGS patients. This includes an on-site registrar, on-call consultant and ready emergency theatre, all available 24 hours a day and without elective duties. The study will compare patient outcomes between the period 2.5 years before and after ASU implementation; that is, from 01/02/2010 to 01/02/2015. Eligible patients will be aged >=18 years at time of admission, and undergo appendicectomy at our institution in the enrolment period 01/02/2010 to 01/02/2015. Patients will be followed from hospital admission until 6months post surgery. Data collected will comprise basic demographic data (age, gender, date/ time of presentation, date/ time of referral to general surgery, date/ time of procedure, open or laparoscopic appendicectomy performed), and outcome data (appendiceal pathology result, date/ existence of documentation of communication of important incidental pathology result surgeon-patient and surgeon-general practitioner, and date/ existence of documentation of appropriate treatment of important incidental pathology).
Sponsors
Dr Ned Kinnear
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients with important incidental pathology on their appendicectomy specimen at our institution between 01/02/2010 and 31/01/2015.
Exclusion criteria
Patients with incomplete data.
Outcome results
None listed