Emergency general surgery 'Hot Clinic': Efficiency, prevention of hospital admissions and factors influencing patient experience

Abstract

Objective: The constant pressure facing hospitals to reduce emergency inpatient admissions has led towards more consultant-led 'Hot Clinics' (HC). The patient experience in these settings remains poorly understood. This study evaluates the efficiency and ability of the HC to prevent unnecessary emergency surgical admissions and factors influencing the patient experience.

Methods: Patients were referred to the HC from the Emergency Department, General Practice or Out-of-Hours service over the initial six-week period. A questionnaire collected the reason for referral, management without a HC, final diagnosis and management. Appropriateness of referrals were evaluated by the HC consultant and retrospectively by a blinded consultant. A second questionnaire collected information on patient satisfaction in a subsequent study period.

Results: 119/126 referrals (94%) were judged appropriate in the HC analysis with 97/126 (77%) considered appropriate in the retrospective analysis. The HC reduced the amount of potential emergency surgical admissions from 114 to 14 (p < 0.001). In the second period, 114/121 patients (94%) rated the HC as very good or good; with privacy (p < 0.05) and decision-making (p < 0.001) linked to patient satisfaction. Comfort (p < 0.05) and decision-making (p < 0.001) were linked to patients recommending the service. 103 patients (85%) would be extremely, or very likely to recommend the HC service with 93 patients (77%) preferring HC treatment over a hospital admission.

Conclusions: Most referrals to the HC were appropriate and it continues to prevent unnecessary emergency surgical admissions. The HC service is valued by NHS patients, who prefer HC treatment over admission. Various factors to improve the patient experience in HC have been identified.

Keywords: Abdominal pain; Emergency general surgery; Gastrointestinal surgery; Hot clinic; Patient experience; Patient factors; Patient satisfaction.