Lawrence Kim1, Swee T Tan. 1. Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Private Bag 31907, Lower Hutt, New Zealand.
Abstract
AIMS: (1) To identify and quantify the causes of delay in surgical intervention for plastic surgery patients presenting acutely to the public hospital; (2) to assess the resultant economic impact; and (3) to propose strategies that may improve the efficiency of acute surgical care. METHOD: All patients presenting acutely to the Wellington Regional Plastic, Maxillofacial and Burns Unit at Hutt Hospital, New Zealand from 27 February to 26 May 2006 were included in this prospective study. Demographic and clinical data, the timing of plastic surgical assessment, and surgical intervention were recorded. RESULTS: Of the 398 patients who presented acutely, 56 were excluded (46 were managed conservatively, 7 required urgent surgery, and 3 in whom the exact time of assessment was not recorded). The interval between assessment and operation of the 342 remaining cases ranged from 55 minutes to 203.9 hours (mean, 32 hours). 91 (27%) patients underwent surgery within 8 hours of presentation. Surgery was delayed for more than 8 (range: 8.1-203.9) hours in the remaining 251 cases, due solely to the lack of operating theatre access in 180 (72%). In these cases the delay between assessment and surgery ranged from 8.1 to 191.5 (mean, 40) hours. During the 3-month study period, the estimated cost of unnecessary accommodation (380 bed-days) and avoidable associated cost of prolonged intravenous antibiotics for the 251 cases was NZ$195,586. CONCLUSION: The lack of operating theatre access is the main reason for preventing timely surgical intervention, which contributes significantly to the cost of acute surgical admissions. Implementation of 'arranged acute operating lists' with a large proportion of these patients being treated as day surgery may lead to improved efficiency and quality of surgical care for plastic surgery patients presented acutely to the public hospital.
AIMS: (1) To identify and quantify the causes of delay in surgical intervention for plastic surgery patients presenting acutely to the public hospital; (2) to assess the resultant economic impact; and (3) to propose strategies that may improve the efficiency of acute surgical care. METHOD: All patients presenting acutely to the Wellington Regional Plastic, Maxillofacial and Burns Unit at Hutt Hospital, New Zealand from 27 February to 26 May 2006 were included in this prospective study. Demographic and clinical data, the timing of plastic surgical assessment, and surgical intervention were recorded. RESULTS: Of the 398 patients who presented acutely, 56 were excluded (46 were managed conservatively, 7 required urgent surgery, and 3 in whom the exact time of assessment was not recorded). The interval between assessment and operation of the 342 remaining cases ranged from 55 minutes to 203.9 hours (mean, 32 hours). 91 (27%) patients underwent surgery within 8 hours of presentation. Surgery was delayed for more than 8 (range: 8.1-203.9) hours in the remaining 251 cases, due solely to the lack of operating theatre access in 180 (72%). In these cases the delay between assessment and surgery ranged from 8.1 to 191.5 (mean, 40) hours. During the 3-month study period, the estimated cost of unnecessary accommodation (380 bed-days) and avoidable associated cost of prolonged intravenous antibiotics for the 251 cases was NZ$195,586. CONCLUSION: The lack of operating theatre access is the main reason for preventing timely surgical intervention, which contributes significantly to the cost of acute surgical admissions. Implementation of 'arranged acute operating lists' with a large proportion of these patients being treated as day surgery may lead to improved efficiency and quality of surgical care for plastic surgery patients presented acutely to the public hospital.