Acute Surgical Unit Emerging from COVID Pandemic: Rural Australian Hospital’s Response to Resource Reallocation

Aim:We compared the management of surgical patients before and after introducing an Acute Surgical Unit (ASU) model within our General Surgical unit during the COVID-19 pandemic.We hypothesized that utilizing an ASU model of care would correlate with improved patient outcomes and more efficient resource allocation during the pandemic.Methods: This is a retrospective study of medical records for surgical patients presenting to Lismore Base Hospital, NSW, Australia, during the imposed COVID restrictions in 2020, three months before and three months after the introduction of the ASU within our surgical department.Time to diagnosis, surgical intervention timing, admission duration, and complication rates were analyzed.Results: 624 patients were included in the study (345 pre-ASU, 279 post-ASU).After the introduction of the ASU, a higher proportion of patients had their operations commenced before 13:00 hrs (25.5% pre-ASU vs. 59.4% post-ASU; P < 0.001).After-hours operating significantly reduced (15% pre-ASU vs. 3% post-ASU).The median time to definitive procedure was reduced (25.5 hrs vs. 19 hrs; P < 0.001), and the average length of stay was shorter (3.0 days vs. 2.0 days). Conclusion:The introduction of the ASU at Lismore Base Hospital significantly improved care and patient outcomes despite the COVID-19 restrictions.It facilitated early senior decision-making, with procedures having increased complexity and duration due to viral precautions being better managed during daytime hours.The ASU model led to more rapid diagnoses and earlier surgeries.Although more patients underwent definitive surgery upon admission, the hospital stay was nearly a day shorter.These improved efficiencies stem from the consultant-led model and a dedicated team available daily to assess and treat patients.Another enhancement in patient care was the rise in patients undergoing surgery during daylight hours.Recent studies have highlighted that operating outside daylight hours is linked to reduced speed, accuracy, and skill, contributing to potentially life-threatening errors [1-3].