38 Adapting an Emergency General Surgery Service in Response to the COVID-19 Pandemic

Introduction In response to the COVID-19 pandemic, our emergency general surgery (EGS) service established an enhanced ambulatory service and undertook non-operative management of selected pathologies. This study compares the activity of our service before and after these changes. Method Patients referred by the emergency department were prospectively identified over a four-week period beginning from the date of reconfiguration (COVID) and compared to patients retrospectively identified from the same period the previous year (Pre-COVID) and followed up for 30 days. Data was extracted from handover documents and electronic care records. Results There were 281 and 283 patients during the Pre-COVID and COVID periods, respectively. Rates of admission decreased (78.1% to 41.7%) whilst there were increased rates of ambulation (7.1% to 17.3%) and discharge (6% to 22.6%). Duration of admission decreased (6.9 to 4.8 days), and there were fewer operative and endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39), telephone reviews (0 to 39), and use of early CT to facilitate discharge (5% to 34.7%). There were no differences in 30-day readmission or mortality in any group. Conclusions Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, whilst maintaining patient safety.

980 An Audit of a Surgical Ambulatory Service [SAmS] Performance Pre And Post COVID-19 - The Impact of Senior Decision Making

Introduction Surgical Ambulatory Units have emerged to refine the management of unscheduled care with the aim of reducing admissions and offering timely, accurate treatment strategies. There are 12 principles which underpin an efficient ambulatory Service, one of which is to have a 'Consultant led and delivered Service'. Consequent to the COVID Pandemic we reallocated Consultants to our Ambulatory Service and reviewed the impact of this initiative. Method Two periods - Pre COVID 6-17/1/20 and Post COVID 27/4 -10/5/20 were compared with respect to volume, case mix, procedures performed and outcomes in terms of investigations, and completed episodes. Data was retrieved from case notes and electronic databases. Results There were no demographic differences across the groups. The case mix and referral patterns were similar as was the volume. There were no differences in procedures or investigations ordered. In the Pre COVID group 20% of sessions were Consultant led compared with 100% in the Post COVID group. In the post COVID group 64% of cases were completed on the index attendance compared with 27% in the pre COVID group. Conclusions A Consultant presence in SAmS enhances decision making and risk management and is critical for the efficacy of the Service with respect to patient flow and resource management.

Ambulatory approach to cancer care. Part 3: starting and maintaining the service and its challenges and benefits

This is the final article in a three-part series. Previous articles discussed the patient experience and the enhanced roles of nurses and the multidisciplinary team (MDT) and their role in safety within ambulatory care (AC) at a major London teaching hospital. There is understandably apprehension when starting a new service and embarking on a new healthcare concept. The challenges of starting and maintaining an AC service are multifaceted. Common questions posed to this London teaching hospital concern the challenges of opening and maintaining a new service and the savings it will produce. There are many indirect savings and benefits to an ambulatory service, although the value of a positive patient experience cannot be measured in monetary terms.