ABSTRACT
BACKGROUND: Hospitals establish surgical assessment units to promote efficiency and improve patient experience. Surgical assessment units are believed to reduce unnecessary admissions. We evaluated a hospital's on-call surgery service without this facility to determine benefits of implementation. METHODS: All emergency surgery referrals made over a 3-month period were recorded, including whether the patient was immediately discharged directly from emergency surgery. Data collection was undertaken by each surgical firm on-call. Immediate discharges were classed as patients not admitted to the hospital overnight (regardless of whether the patient had outpatient follow-up planned). RESULTS: Nine hundred eighty-four referrals were identified. Seven hundred ninety-three referrals had complete data and therefore were included for analysis. Of these, 349 patients (44.0% of referrals) were immediately discharged from emergency surgery, thereby preventing unnecessary admissions (a high proportion of surgical referrals not requiring hospital admission). This improves hospital efficiency, cost savings, and patient experience. Immediate discharge was less frequent and more difficult to accomplish if patients were initially assessed on wards (instead of in the emergency department). This is likely due to patients' perceptions that admission was required when transferred from emergency department to a ward. CONCLUSIONS: Establishment of surgical assessment units has multiple potential benefits to patients, hospitals and clinicians. Appropriateness of surgical assessment unit implementation by every hospital ought to be evaluated.
Subject(s)
Emergency Service, Hospital , General Surgery/statistics & numerical data , Patient Discharge/statistics & numerical data , Referral and Consultation/statistics & numerical data , Surgery Department, Hospital , Cost-Benefit Analysis , Emergency Treatment/methods , General Surgery/economics , Humans , Organizational Innovation , Patient Discharge/economicsABSTRACT
Spontaneous vaginal evisceration of the small bowel is a rare event. It is precipitated in the postmenopausal woman commonly by hysterectomy and in the premenopausal woman by vaginal trauma. We report a case of a 75-year-old woman presenting with a protruding mass in her vagina and associated abdominal pain. A combined laparoscopic and transvaginal method of repair is described and the advantage of using both techniques highlighted.
Subject(s)
Ileal Diseases/surgery , Ileum , Laparoscopy/methods , Vaginal Diseases/surgery , Aged , Female , Humans , ProlapseABSTRACT
BACKGROUND: Gallstone ileus remains a rare but important cause of intestinal obstruction. METHOD: We present a unique case of two gallstones causing intestinal obstruction at the same time. RESULTS: A 90-year-old lady presented with signs and symptoms of small bowel obstruction. At operation, two gallstones stuck at different points within the bowel were causing the obstruction and were removed. CONCLUSION: When operating on patients with small bowel obstruction from gallstone ileus, examination of the entire small bowel should be considered mandatory.
