AB195. 172. Implementing direct general practitioner referral pathways to the acute surgical assessment unit in Galway University Hospital

Background: The Acute Surgical Assessment Unit was established in Galway University Hospital in November 2017. Throughout its first year, referrals were made by Emergency department triage to the unit. In October, we introduced a direct general practitioner referral pathway, allowing surgical patients to be admitted to the surgical assessment unit directly for surgical assessment.

Methods: An initial small pilot study involving a limited number of medical centres was preformed over a 2-week period to gauge the response and mediate pitfalls. Following this, a document outlining strict referral guidelines for general practitioners was disseminated to all practices in the hospital’s catchment area. Over the subsequent 2 weeks we conducted a prospective audit on GP referrals.

Results: We saw a 16% increase in total number of patients attending the acute surgical assessment unit. There was an inverse relationship between triage referrals and general practitioners referrals, there was an average 90 min reduction in-patient experience time and most importantly, we saw a 41% reduction in surgical admissions from the unit during the audit period. During the study period there were 2 inappropriate referrals, 2 patients directed toward urgent outpatient appointments and 8 calls requesting advice about referral pathways to other surgical services.

Conclusions: This audit confirms that the introduction of a direct general practitioner referral pathway does not result in an increase of inappropriate referrals to an acute surgical assessment when direct GP were introduced. In fact our data suggests that direct access can significantly reduce the number of unnecessary acute surgical admissions. Inappropriate emergency surgical admissions reduce the number of available beds and decease the rate of treatment of elective patients and hereby reduce the efficiency of the surgical service.

Keywords: Surgical assessment unit