Post-Operative Care Following Appendicectomy: Are We Getting it Right First Time?
Abstract
Background
Commissioned by Royal College of Surgeons and NHS Improvement in 2017, the ‘Getting It Right First Time – General Surgery’ (GIRFT) report was created to improve the quality of care and to reduce unwarranted variations in service and practice1. Working to the principle that a patient should receive the same timely, quality, treatment and outcomes regardless of where they are treated within the NHS. The GIRFT programme was initially piloted on orthopaedic surgery where after being implemented for a 12-month period it had already delivered savings of around £30 million; with most of the savings coming from reducing the length of time the patient spends in the hospital1.
Following on from this the GIRFT programme identified that there is a significant variation in length of stay (LOS) after an appendicectomy. Nationally, the average LOS for an adult was 3.5 days. However, leading trusts are able ‘to discharge over half of patients within two days of admission’1. It is estimated that if all providers were able to match this performance 30,000 bed-days and £8.5 million per year could be saved1.
Aim
The primary aim of this study was to analyse the length of hospital stays following appendicectomy at Stockport NHSFT. Additionally, we aimed to identify the factors preventing early discharge in patients with uncomplicated appendicitis i.e. those who should not require protracted post-operative care.
Type of study and place of study
The study is a retrospective clinical audit that took place at Stockport NHSFT (Stepping Hill Hospital), United Kingdom.
Method
A list of all patients that underwent an appendicectomy in the allocated time range was obtained from the hospital database and fully anonymised. The results were secured on a password protected EXCEL spreadsheet and not removed from the hospital premises to ensure data protection. The Stockport NHSFT hospital systems: Advantis EDS and EPRO were used obtain the patient’s clinical notes which provided further details regarding why a patient had a prolonged LOS post-operatively. Discharge summaries and operative notes were used to calculate LOS and classify patients as either ‘complicated’ (evidence of perforation, empyema or abscess formation) or ‘uncomplicated’ appendicitis. The 48-hour target set by GIRFT was employed as the audit standard – ‘All patients presenting with appendicitis who undergo uncomplicated appendicectomy should be discharged within two days of admission’1. In cases of uncomplicated appendicitis with an inpatient LOS >48 hours, the clinical notes were analysed to identify any causes of the delayed discharge.
