273 Evaluating Referral Appropriateness to the Surgical Acute Ambulatory Care Unit (AACU) Altnagelvin Hospital

Abstract Aim To evaluate compliance with established referral standards for the Surgical Acute Ambulatory Care Unit (AACU) and assess the appropriateness and outcomes of referrals received over a defined period. Method A prospective audit was conducted between April 14th and May 9th, 2025, involving 151 patients referred to the Surgical AACU. Data were collected using a structured pro forma capturing referral source, presenting complaint, NEWS at referral, diagnosis, and clinical outcome. Compliance was assessed against NHS Improvement and Ambulatory Emergency Care Network (2018) guidelines for same-day emergency care. Results Only 62% of referrals met AACU selection criteria. Of the 38% deemed inappropriate, 31 cases could have been managed in GP or outpatient settings, and 23 required full admission. Most referrals originated from the Emergency Department (57), followed by ACU review (32), ward review (24), GPs (19), and surgical team (15). Blood tests were the most common intervention (105), followed by clinical assessment (73) and imaging (55). small amount of referrals were made for pre-operative checks, and a small number were for inappropriate purposes such as breaking bad news. Biliary colic (35) and post-op wound issues (24) were the most common presentations. Overall, 75% of patients were appropriately managed and discharged on the same day, with a 15% admission rate falling within acceptable NHS thresholds. Conclusions The audit highlights the effectiveness of the AACU when used appropriately but reveals a significant proportion of inappropriate referrals. Improved gatekeeping, clearer referral pathways, and targeted education are recommended to enhance efficiency and ensure guideline-based use.