• Enda Hannan and Sherif El-Masry.
• Department of Surgery, Our Lady of Lourdes Hospital Drogheda, 109 Howth Road, Howth, Dublin 13, Ireland. endahannan@rcsi.ie.
• Ir J Med Sci. 2022 Jun 1; 191 (3): 1361-1367.

BackgroundAcute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional 'on-call' emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery.AimWe set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED.MethodsPatients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts.ResultsIn the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed.ConclusionsThe ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.© 2021. The Author(s).

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