A specific criteria-based guideline improves compliance with General Surgery ambulatory care standards and reduces overcrowding in a Hot Clinical: A closed-loop prospective clinical audit

Abstract

Ketevan Papidze

ABSTRACT
Aims: General Surgery ambulatory clinic or “Hot Clinic” (HC) are largely overcrowded nowadays and it has become a major issue.
We performed a prospective audit to assess what proportion of patients attending HC meet the criteria for ambulatory care. We aimed
to implement a specific criteria-based guideline and monitoring programme in order to improve the compliance with the ambulatory
care criteria.
Methods: The audit included three cycles: baseline audit (30 days in September 2018), first re-audit (30 days in January 2019), and
second re-audit (30 days in May 2019). Compliance with the HC standards was considered as the outcome measure (target: 100%).
After a baseline audit, we implemented a specific criteria-based guideline for HC and designed a monitoring programme maintain the
compliance with the guideline.
Results: During the baseline audit, 224 patients were seen in HC. After implementation of the guideline this was reduced to 40
patients in first re-audit and 42 patients in second re-audit. The median number of patients seen per day was significantly higher in
the baseline audit [7(6-8)] compared with first re-audit [1(1-2),P<0.0001], and second re-audit [1(1-2),P<0.0001], however during
the baseline audit, only 19% of patients had been seen by the General Surgery team prior to HC and only 19% of patients met the
eligibility criteria for review in HC; both improved to 100% in the first re-audit (P<0.0001) and remained 100% in second re-audit
(P<0.0001).
Conclusions: Implementation of criteria-based guideline suggested in this study led to improvement in the compliance with General
Surgery ambulatory care standards and reduction in overcrowding of HC.

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