EP.FRI.574 Screening tool to improve patient referral to acute surgical care from Emergency Department

The study aimed to audit the appropriateness of surgical referrals to general surgery; and, secondly, to devise a screening tool for use in the emergency department  to screen patients that are safe to be discharged and to be seen in surgical ambulatory clinics. Methods The first phase of the study was an audit to check appropriateness of the surgical referrals (1st-18th February 2020). In the second part, a screening tool questionnaire was prospectively tested (1st February-24th March 2020) on the surgical referrals. The accuracy of the screening tool outcome was compared to actual patient consultation outcomes. The sensitivity and specificity of the questionnaire was assessed using an ROC curve. Results In the first audit, 68.9% patients were discharged on the same day with or without follow up in the ambulatory surgical clinic.  In the prospective questionnaire phase of the study, there were 98 patients and the most common presentation was abdominal pain (n = 60) followed by urological symptoms (n = 11), symptoms of hernia complication (n = 10), abscess (n = 7) and testicular pain (n = 2). The sensitivity and specificity of the screening tool was 60.7% and 100%, respectively with overall accuracy being 88.82%. The area under the ROC curve was 0.80. Conclusion A large proportion of the patients referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool has the potential to screen patients who can be seen in the ambulatory clinic and safe to identify patients who require urgent surgical admission.