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 To look at the adequacy of management of abdominal symptoms by A+E SHOs Two hypotheses: Two hypotheses: That there is inadequate disposal of patients by A+E SHOs 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 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” 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 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: The A+E cards were studied and the following information noted:

Methods Date of attendance Date of attendance Age Age Sex Sex Diagnosis Diagnosis Management Management Disposal Disposal Whether or not patient returned, and why Whether or not patient returned, and why Return disposal Return disposal

Results 169 patients 169 patients 68 males, 101 females 68 males, 101 females Mean age 50.2 years, range 17 – 94 years Mean age 50.2 years, range 17 – 94 years 39 (23.1%) patients returned 39 (23.1%) patients returned 20 males, 19 females 20 males, 19 females Mean age 54.9 years, range 18 – 94 years Mean age 54.9 years, range 18 – 94 years Two patients are frequent attenders with the same complaint Two patients are frequent attenders with the same complaint Delay between first and return visits: Delay between first and return visits: Mean 28 days, range ½ hour to 107 days Mean 28 days, range ½ hour to 107 days

Results 20 patients (11.8%) returned for the same condition 20 patients (11.8%) returned for the same condition Half of these had been admitted on the first visit, and seven required re-admission 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. Of those who were discharged on first visit, 2 were admitted on return.

Flaws with audit Retrospective audit Retrospective audit Patients who represented by a different route, e.g. to their GP, are missed 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 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 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 proportion of patients are inappropriately discharged on initial presentation. A small number of patients discharged from surgical wards re-present with the same problem. A small number of patients discharged from surgical wards re-present with the same problem.