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The Virtual Ward as a resource to convert emergency presentations to day case procedures

Jacobus Schutte1, Mihai Paduraru2, Luke Evans3
1St George University, St George, Grenada. 2NNUH, Norwich, United Kingdom. 3NNUH, Norfolk, United Kingdom


Introduction: Biliary presentations account for around 1/3 of the emergency general surgery workload in the UK and the logistics of treating these patients are notoriously difficult to negotiate. We have taken advantage of the recent development for virtual ward services, set up in response to the pandemic, to provide a "third way" between emergency and elective work. The pathway and outcomes from the first 18 months of the service are described here.

Methods: In most cases, emergency attenders are unable to access elective beds and the emergency theatre is not used for elective admissions. The pathway allows patients presenting as emergencies with biliary problems to be transferred to the virtual ward (either from inpatient beds or our Same Day Emergency Care (SDEC) unit) thus technically remaining an "inpatient" and being able to access the emergency theatre booked slots, whilst at the same time being able to isolate and so be readmitted through the ring-fenced elective beds.

Results: In the first 16 months we were able to move 115 patients through this pathway. Although every case was an emergency "hot gallbladder" we treated all as day-case by intent and achieved it in 47%. Median Post-op LoS was 1d. 10 patients stayed >48hr. Median ASA was 2. Median pre-op LoS 5d

Conclusions: The use of the virtual ward as a bridge from the emergency to the elective has had a significant impact in our ability to continue offering excellent, planned-emergency care and to mitigate the disadvantages faced by emergency admissions.