Hotel NHS and the Acute Abdomen – admit first, investigate later.

Kamal Aryal (1) , Arnab Bhowmick (1) , Alan Beveridge (1) , Nigel A. Scott (2)

1 Colorectal Surgery
2 Colorectal Surgery

Aim To determine, for patients with an admission diagnosis of suspected acute abdomen, the financial consequences of a policy of admission first –followed by definitive investigation. Results Over a one month period 122 patients were admitted with a suspected surgical diagnosis of acute abdomen - (55 male, 67 female); age range 16 to 95 years (median 56.5). Based on either surgical operation required (n=36), death after admission (n= 6 - 3 postoperative deaths) and/or severe surgical illness (n=17) – 56 required surgical in-patient admission, while 66 did not. Those patients that did not require admission, spent significantly shorter time in hospital than those that required admission (median 5 days v 8.5 days; p=0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall £205,468 was consumed by those 56 patients that required admission whilst £125,000 was spent on 66 patients whose clinical course did not justify admission – 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and Conclusion On a national basis emergency General Surgery admissions account for 1,000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first - and then requesting definitive investigation makes neither clinical nor economic sense.

Mots clés: Medicine

Kamal Aryal, Arnab Bhowmick, Alan Beveridge, Nigel A. Scott. Hotel NHS and the Acute Abdomen – admit first, investigate later.. International Journal of Clinical Practice, 2009, 63 (12), pp.1805. ⟨10.1111/j.1742-1241.2009.02217.x⟩. ⟨hal-00532547⟩