Improving Quality Metrics with a Day-only Skin Abscess Protocol: Experience from Australia

Area of Science:

• Emergency Medicine
• Surgical Protocols
• Healthcare Management

Background:

• Skin abscesses frequently require surgical incision and drainage, often facing delays due to theatre access.
• These delays contribute to increased management costs and prolonged patient stays.
• The long-term impact of a standardized day-only protocol for skin abscesses in a tertiary setting was previously unevaluated.

Purpose of the Study:

• To evaluate the impact of a day-only skin abscess protocol (DOSAP) on emergency surgical management of skin abscesses.
• To assess the long-term utilization and effectiveness of DOSAP in an Australian tertiary institution.
• To provide a replicable model for other healthcare facilities.

Main Methods:

• A retrospective cohort study compared outcomes before and after DOSAP implementation across three periods (2014-2022).
• Data included length of stay, delay to theatre, theatre start times, representation rates, and total costs.
• Statistical analysis utilized nonparametric methods to compare outcomes.

Main Results:

• DOSAP implementation led to a significant decrease in ward length of stay (1.25 to 0.65 days) and delay to theatre (0.81 to 0.44 days).
• Theatre start times before 10 AM increased significantly post-DOSAP.
• Median admission costs decreased by $711.74 (inflation-adjusted), with 1,006 abscesses managed via DOSAP over four years.

Conclusions:

• The day-only skin abscess protocol (DOSAP) was successfully implemented in an Australian tertiary center.
• The protocol demonstrated significant improvements in efficiency and cost-effectiveness.
• The ongoing utilization confirms the protocol's ease of applicability and suitability for broader adoption.