A+E SHO management of abdominal symptoms Audit by Mrs. Kirsty Cattle A+E SHO, Royal Glamorgan Hospital
Aim of audit • To look at the adequacy of management of abdominal symptoms by A+E SHOs • Two hypotheses: • That there is inadequate disposal of patients by A+E SHOs • That surgical patients recently discharged from the ward re-present frequently to A+E
Methods • Adult patients, attending during the period 1/8/03 to 30/9/03, whose visit was coded as “Gastrointestinal” or “Abdomen” • A search was made on each of these patients on the A+E computer system using the date of birth, to identify repeat visits until 30/11/03 • The A+E cards were studied and the following information noted:
Methods • Date of attendance • Age • Sex • Diagnosis • Management • Disposal • Whether or not patient returned, and why • Return disposal
Results • 169 patients • 68 males, 101 females • Mean age 50.2 years, range 17 – 94 years • 39 (23.1%) patients returned • 20 males, 19 females • Mean age 54.9 years, range 18 – 94 years • Two patients are frequent attenders with the same complaint • Delay between first and return visits: • Mean 28 days, range ½ hour to 107 days
Results • 20 patients (11.8%) returned for the same condition • Half of these had been admitted on the first visit, and seven required re-admission • Of those who were discharged on first visit, 2 were admitted on return.
Flaws with audit • Retrospective audit • Patients who represented by a different route, e.g. to their GP, are missed • Insufficient time elapsed between study period and data collection, thereby missing later returnees. However, longer time elapsed will pick up more patients returning with unrelated problems
Summary • A large proportion of patients who attend the A+E department with abdominal symptoms will return (23.1%), half of whom (11.8%) return with the same problem. • A small proportion of patients are inappropriately discharged on initial presentation. • A small number of patients discharged from surgical wards re-present with the same problem.