G. Cooper J et al. – The management of stable acute abdominal pain (AAP) within the emergency department (ED) environment on a well–defined clinical decision unit (CDU) pathway is feasible and can facilitate safe, efficient and effective care with early discharge and an increase in the accuracy of the final diagnosis.
- An initial retrospective cohort study of consecutive patients presenting to the ED with undifferentiated AAP were analysed.
- Data were extracted on admission, length of stay and the correlation between initial ED clinical diagnosis and final discharge diagnosis.
- Following this, a protocol was developed within the institution for the management of patients with stable AAP on a CDU pathway.
- This was then formally evaluated over a period of 25 months as part of a quality improvement exercise.
- A total of 501 patients were analysed of whom 48% were admitted from the ED.
- The initial ED diagnosis was correct in 57% of patients, and 28% of admitted patients were discharged within 48h with no specific intervention.
- During the period of the pilot study, 189 patients were entered on to the AAP CDU pathway, of which 85% were safely discharged directly from the CDU and 67% within 24h.
- Of the 28 patients admitted only four required an operation.
- Use of the protocol in this population resulted in the initial ED assessment being correct in 69% of cases.