Emergency Department Models of Care 2012 - NSW Health

4.2 Surgical Assessment UnitWhat is the model?A SAU is a specialised unit (e.g. surgical beds converted to SAU beds) that provides a fasttrackroute for the assessment of acute adult surgical patients.The SAU reviews and/or admits stable patients from the ED, direct admissions from theOutpatients Department and Visiting Medical Officers Rooms, inter-hospital transfers, andweekend and public holiday presentations.The SAU provides a focal point for emergency surgical admissions in the hospital, providingrapid assessments by senior medical staff followed by prompt investigations and treatmentor discharge.The service enables all surgical specialties (excluding obstetrics and gynaecology,neurosurgery and cardiothoracic) to be assessed and admitted or discharged.To support improved care of emergency surgery patients, Emergency Surgery Guidelineshave been developed by NSW Health and define the principles underpinning the redesign ofemergency surgery in NSW. The benefits of emergency surgery redesign include improvedpatient outcomes, enhanced patient and surgical team satisfaction and increased traineesupervision in emergency surgery. The guidelines can be found at: http://www.health.nsw.gov.au/policies/gl/2009/pdf/GL2009_009.pdfWhy use the model?The SAU is used to address the challenge of reducing delays for the assessment of surgicalpatients, and promoting senior medical review early in the patient’s care.Key principles ■ Reduce delayed surgical assessment and decision-making for unscheduled generalsurgical patients■■■■■■■■Cater for acute surgical admissions from the ED, clinics, inter-hospital transfers and theDay Only wardA patient’s stay in the ED is as short as possiblePatients are admitted directly into the Surgical Assessment Unit (SAU) after the surgicalconsultant has accepted careFocal point for rapid assessment of surgical patients for plan of care:Coordination of further assessment and diagnostic testsObservationPreparation for theatre.Develop surgical admission and discharge officers.Benefits of the model ■ Reduced access block for surgical patients (Westmead hospital reduced their access blockby up to 43% in 2007)■Improved flow for all patients presenting for treatment in the ED by freeing up ED bedsof surgical patients.Challenges ■ Establishing guidelines between surgical staff and ED on how surgical patients will bemanaged.■This Model of Care does not have strong governance.PAGE 50 NSW HEALTH Models of Emergency Care