Efficiency of Abscess Pathway

Aliasger Amin, Anil Reddy, Madan Jha, Ahmed Hammad. James Cook University Hospital

Objective: Conventionally, patients with abscess admitted under surgery were operated according to the availability of emergency operation theatres. Other emergency procedures took priority, delaying the incision and drainage of abscess. This resulted in long waiting time and unnecessary overnight stay and costing National Health Service approximately 250 pounds a day. The aim of the study was to develop a pathway for increasing efficacy and evaluating it.

Methods and Procedures: An abscess pathway was developed wherein a special slot was created in operating theatres for incision and drainage (I&D) of abscess at a set time. Patients presenting with an abscess, without significant medical comorbidities, were assessed, consented and then allowed to go home. They were given appropriate preoperative instructions and then admitted to the surgical day unit at the specified time for I&D. The length of stay of 30 patients, who had I&D, before the abscess pathway was introduced (data collected retrospectively), was compared with that of 30 patients, after the abscess pathway was introduced (data collected prospectively).
Results: The average length of stay of 30 patients before the introduction of abscess pathway was 33 hours and 19 of those patients had I&D done on the next day of admission. Average length of stay of 30 patients after the introduction of abscess pathway was 16 hours and all of them had the procedure done on the day of admission.
Conclusion: Abscess pathway decreased the hospital stay of medically fit patients after I&D, by half, improving efficiency and cutting costs. These patients were admitted in surgical day unit leading to release of acute surgical inpatient beds for managing other emergencies. The specific slot in theatres for I&D provided a training opportunity for junior doctors.