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Introduction Early involvement and management by specialists has been shown to have a favourable impact on outcomes in a number of acute medical conditions. Delivery of high quality acute medical care by specialists has been highlighted as an aim by the Darzi review in 2008. We aimed to provide a high quality, trainee-led, daily reach-in gastroenterology service during weekdays for acute gastroenterology patients admitted to the medical assessment unit(MAU) at a busy district general hospital. The role of these reviews is to expedite specialist input to patients with the aim of improving clinical outcomes and time of discharge. Methods We introduced a daily gastroenterology retrieval service for patients admitted to the Medical Assessment Unit (MAU) for 4 weeks in January 2018. The retrieval team reviewed acute gastroenterology patients admitted from the take and advised on investigations, management plan and if appropriate took over the care. A mathematical model was created of non-retrieved patients (n=27) to simulate outcomes without gastroenterology intervention for comparison. Results 27 patients were referred in the 4 week period. Common reasons for referral included GI bleed (51.9%), diarrhoea (14.8%), liver related problems (22.2%) and upper GI symptoms i.e dysphagia, persistent vomiting, etc. (11.1%). Following retrieval, 19 patients were moved to the gastro ward (70.4%) and there was no bias towards any one diagnosis being repatriated (p=0.309). The median time for arrival to the GI ward was 2 days. The median length of time the retrieval group patients were deemed medically fit was 4 days. Liver patients stayed longer (median 6.5 days, range 3–10), whilst IBD patients stayed the shortest (median 2.5 days, range 1–5). Across the retrieved patients, an estimated median value of £400 was saved per patient and total of £16 700 was saved over a 1 month period based on bed stays and early discharges. A median of 1 day was saved per patient, with a total of 32 hospital days saved across the 27 patients retrieved. Compared to our modelled non-retrieved patients, the number of days saved by the retrieval service was statistically significant, (1.19 days+/-0.233 in the retrieved group compared to 0.05 days+/-0.048 in the modelled group), p Conclusion We present a model of acute gastroenterology service delivery which is cost effective, facilitates early discharge and is associated with improved outcomes irrespective of the underlying diagnosis of these complex patients. This would thereby pave way for excellent learning and leadership opportunity for specialist trainees. |
