1. Lewisham and Greenwich
GP Matters
New Surgical Assessment Units (SAU): Information for GPs
In January 2015, Lewisham and Greenwich NHS Trust opened a Surgical Assessment Unit (SAU) at University Hospital Lewisham, following
the opening of the SAU at Queen Elizabeth Hospital in December 2014.
GPs can refer patients directly to the unit so they can receive early access to treatment and diagnostics from specialist surgical teams.
At University Hospital Lewisham (UHL), the SAU treats general surgical presentations. The SAU at Queen Elizabeth Hospital (QEH) accepts patients
with a range of surgical and orthopaedic presentations (inclusion and exclusion criteria can be found below).
Patients will be assessed on the unit, and treated if appropriate, before being discharged home or admitted to a ward.
University Hospital Lewisham
The SAU consists of 4 trolleys located on Cedar Ward.
Because of the large amount of elective work carried
out at UHL, this location ensures that elective and
emergency flows can, wherever possible, be separated
for good logistical and clinical reasons – including easy
access to lifts for theatre/imaging.
Queen Elizabeth Hospital
The SAU consists of 6 trolleys located within the AMU;
this location ensures that patients are placed within
a clinically safe environment where experienced staff
and Doctors are available should the need arise for
emergency surgical intervention.
Opening Times
The units are open 7 days a week from 08.00–19.00
and patients can be referred to the service either
by their GP or by the Emergency Department.
The last admission will be 18.00.
Prioritising SAU Patients
If the patient
is referred to
radiology by
the SAU for a
CT or MRI scan,
they will be
prioritised at
the same speed as patients being referred by the
Emergency Department.
Two ultrasound slots will be kept available for
‘same day scans’ for SAU patients on each site to
facilitate early diagnosis and possible discharge.
The length of stay on the SAU should be no longer
than 4 hours.
If the patient needs to be admitted, they will be
transferred to a bed on the appropriate ward.
SAU Accommodation
Description of Service
(i) The On-call Surgical/T/O SHO (UHL) and
Surgical SHO (QEH) are available to cover the
unit; the On-call Registrar is also available to
attend as required.
(ii) Following assessment by the surgical SHO/
Registrar; further diagnostic testing may be
requested e.g. CT/US.
(iii) Patients will be informed as soon as a
differential diagnosis has been identified as
to whether they will require admission to a
surgical ward or can be discharged home.
(iv) Patients who can be safely discharged will be
notified if any follow up is required. They will
also be given a discharge summary letter to
hand into their GP and where necessary any
medications that the doctor requests.
(v) Patients who require hospital admission will
have a bed identified on the most
appropriate ward.
Inclusion and Exclusion Criteria
Inclusion Exclusion
w Abcess
w Appendicitis
w Cholecystitis
w Diverticulitis
w Foreign Bodies
w IBS/Abdo pain
w Obstructive Jaundice
w Wound infections
w Prolapse (bowel)
w Pseudo Obstruction
w Stoma related conditions
w Ambulatory patients (e.g. Rigid sigmoidoscopy)
w Dressing changes
w Obstetrics
w Patients under 16 years
w Haemodynamically unstable patients
w NEWS score of >5 or 3 in one
parameter that would fit into the
amber “sick” level of amber score
w Exacerbation of COPD requiring
treatment in addition to the
suspected surgical problem
w Known C-DIFF/MRSA
w Infective Diarrhoea
w Acute Confusion
University Hospital Lewisham:
To refer a patient to the SAU at University Hospital Lewisham, please contact the Surgical
Registrar by:
w Calling 020 8333 3000 and requesting the surgical registrar
w Calling 020 8333 3000 and requesting to bleep 2000
Queen Elizabeth Hospital:
To refer a patient to the SAU at Queen Elizabeth Hospital, please contact the Surgical or
T+O Registrar by:
w Calling 020 8836 6000 ext 4127
w Calling 020 8836 6000 and requesting to bleep 308
How to refer to the SAU

2. Patient Pathway for GP Referrals
GP wishes to refer a patient to secondary care
REG in discussion with GP triages patient and
agrees appropriate pathway
Nurse in Charge to contact GP and inform them of the time frame to send the patient in
(this may be earlier than agreed time between the GP and Registrar, but not later)
University Hospital Lewisham,
Lewisham
Emergency Department SAU Assessment OPA Pathway
GP phones Surgical Registrar on-call on
Tel 020 8333 3000 Bleep 2000
If patient requires emergency
treatment that cannot be delivered
in an SAU setting.
GP to contact LAS and arrange
emergency transfer in line with
normal practice.
w Patient needs access to the
Surgical Assessment Unit to
undergo urgent investigation and
further assessment.
w Registrar to discuss with GP
clinical time frame required for
admission (eg within 2 hours, 4
hours or 6 hours).
w Registrar to bleep Nurse in
Charge of SAU and inform them
of patient.
IfanalternativetoaSAUpresentation
couldbeconsidered(eg:urgentOPA),
Registrar to take patient details and
instigate alternative pathway via
usual routes.
GP phones Surgical or T+O Registrar on
Call on Tel 020 8836 6000 Bleep 308 or
ext 4127
Queen Elizabeth Hospital,
Greenwich