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Waiting for definitive care: An analysis of elapsed time from decision to surgery or transfer in a rural centre
Author(s) -
Dobson Hannah,
Ranasinghe Weranja K.B.,
Hong Matthew K.H.,
Bray Lilia.,
Sathveegarajah Manivannan,
Vally Fatima,
Miller Francis J.
Publication year - 2015
Publication title -
australian journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.48
H-Index - 49
eISSN - 1440-1584
pISSN - 1038-5282
DOI - 10.1111/ajr.12160
Subject(s) - interquartile range , medicine , referral , retrospective cohort study , emergency medicine , intensive care unit , transfer (computing) , cohort , emergency department , surgery , intensive care medicine , family medicine , nursing , parallel computing , computer science
Objective To examine the timing of operative management and interhospital transfer of emergency general surgical patients in a regional setting. Design Retrospective cohort study. Setting The surgical unit at a major rural referral centre for N orth‐ E astern V ictoria servicing a population of 90 000. Participants General surgical patients ( n = 649) admitted via the emergency department at N ortheast H ealth W angaratta between J anuary 2011 and M arch 2013 undergoing operative management ( n = 608) or transfer to a tertiary centre ( n = 44). Main Outcome Measures Timing of operative management, using appendicectomy as a benchmark operation, was measured as time from presentation to decision to operate, time from decision to surgery, percentage after‐hours operating and length of stay ( LOS ). Time to interhospital transfer was calculated and reasons for delay were sought. Results Two hundred forty‐six appendicectomies were performed. Median time from decision to operate to theatre was 3 hours (interquartile range ( IQR ) 2–8), and total LOS was 43 hours ( IQR : 28–56). Two hundred seventy‐two procedures (43%) were performed out‐of‐hours, including 48% of appendicectomies. Median time from decision making to transfer was 10.3 hours ( IQR : 4.7–25). Transfer was less likely to be delayed in trauma patients when compared with urgent non‐trauma patients (5.3 versus 10.6 hours; P = 0.04). Conclusion Even in the absence of a strict four‐hour rule program and a dedicated emergency surgical unit, main outcome measures appear to be comparatively efficient. However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non‐trauma transfer from rural centres and bed availability in tertiary hospitals.