Improving Patient Flow in the Surgical Assessment Unit by Facilitating Access to Computer Tomography Scanning

Introduction Patient flow is "the ability of healthcare systems to manage patients effectively and with minimal delays as they move through stages of care". National Health Service (NHS) England has highlighted the importance of improving patient flow, and the many benefits to both staff and patients, including: "improved clinical outcome and experience of patients"; "eliminating waits and delays"; "saving time and effort by avoiding duplication of work"; "saving money"; and "improving the reputation of the NHS". Limited access to computerised tomography (CT) imaging for surgical patients can disrupt patient flow through delayed diagnosis, management, and discharge. The aims of this quality improvement project were to assess the effect of a dedicated Surgical Assessment Unit (SAU) radiologist on access to CT scanning and its impact on patient flow. The measured outcomes were time from admission to CT scanning, and length of admission. Method In June 2020, a radiology registrar was allocated to the SAU to vet and report CT imaging. CT requests from the SAU were identified from Picture Archiving and Communication System (PACS) in the first two weeks of June 2019 and 2020 during normal working hours (Monday to Friday, between 0900 and 1700). We performed a retrospective audit and compared data from 2019 and 2020. The measured primary outcome was time from admission to imaging. The secondary outcome was the length of admission. Results In the two-week period in June 2019, 25 patients requiring a CT scan presented to SAU during normal working hours. In 2020, this number increased to 40 patients. In 2019, 5 patients had a CT scan performed within four hours of admission (20%). In 2020, following the allocation of a radiologist to the SAU, 33 patients (82.5%) had their CT performed within four hours of admission. In 2019, one patient (4%) was discharged within six hours of admission. A further 16% had a length of admission between six and 12 hours. The majority of patients (80%) remained in the hospital for more than 12 hours. In 2020, 45% of patients were discharged within four hours following a CT scan. More than half of the patients (57.5%) were discharged within 12 hours. Conclusion The allocation of a radiologist in the SAU led to both a reduction in time to perform CT scans and an increased number of patients being discharged within 12 hours. These results suggest that early access to imaging improves patient flow. Further research will help to establish whether the allocation of a radiologist in the SAU is a beneficial and cost-effective method of improving patient flow, and whether this may help reduce the current pressure on NHS services.