We got front-door-to-decision time under an hour. It’s just doing the simple things right.
I’m Chief Resident on the Surgical Emergency Unit in Oxford, and I lead our audit and quality improvement. I work with acute surgical patients at the front door. The number we cared about was how long from arriving to a decision: admit, discharge, or come back to our ambulatory clinic for a review.
On a traditional take, abdominal pain arriving at 6pm gets clerked, then waits for bloods, then imaging, then a registrar between theatre cases. Hours go by before anyone senior makes the call.
That’s the usual pattern. Making the decision doesn’t really take long. Getting the patient in front of someone senior enough to make it, with the bloods and imaging they need, is where the time goes.
So what did we actually change? Two things did most of the work.
Point-of-care blood tests, so the results are there at the front door. And a senior clinician making the decision on imaging early. Together, they’re what got us within the hour.
Two other numbers moved too. Average bed-days per admission came down by more than two, and adverse events fell by 20%. We presented the results at the ASGBI International Surgical Congress last year.
It’s our own audit on one unit, not a trial, so I wouldn’t credit the hour with all of that. But a lot of the right treatment waits on that decision. I’d be surprised if it wasn’t part of it.
