The document discusses a quality improvement project at Northampton General Hospital to identify areas for improving the management of patients in the hospital's "hot surgical clinic". The clinic was intended to reduce burdens on the emergency department and avoid unnecessary admissions. During a 3-month review, some issues were identified, including patients sometimes being referred inappropriately, overcrowding in the surgical assessment area, and lack of senior support and documentation. Improving adherence to guidelines on inclusion/exclusion criteria, ensuring reliable senior support, and developing local guidelines could help address these issues and better manage patients in the hot surgical clinic.

1. Abstract
The conceptof ‘HotSurgical Clinic’ was developed in order to reduce the
burden on the A&E Department and avoid un-necessary admissions, thus saving
beds for the hospital and minimizing financial costs.
The aim of this quality improvement project is to identify the current
management of care for surgical patients in the hot clinic at Northampton
General Hospital and the potential areas of improvement. Guidelines on the
management of hot clinic surgical patients(HSC) were outlined in the
Commissioning guide 2014 on Emergency general surgery-1.3 Emergency
surgery ambulatory care (ESAC) pathway by the Royal College of Surgeons
and ASGBI. During the 3 months review it was noted that some of the patients
were referred to the HSC inappropriately due to a number of reasons: 1)lack of
decision making by the doctorfirst assessing the patient; 2)patients brought
back to HSC instead of being referred to the outpatient department to be
reviewed in the clinic 3) small number of patients were referred to HSC directly
by the A&E doctors without prior consultation with the surgical team. This has
led to overcrowding of the Surgical Assessment area (ACC, currently know
SDEC) and high levels of pressurefor the on-call team on specific days. Other
issues identified included no senior input (patients managed by SHO only due
to unavailability of the registrar/consultant), missing discharge letters, long
waiting hours (registrar/consultant scrubbed in theatre or busy assessing patients
in A&E). It is of courseclear that the COVID-19 pandemic contributed to some
of these problems identified and the constant restructure of the hospital/COVID
guidelines and rota made things worst, however it is highly possiblethat part of
these issues were present before the pandemic. In order to improve this the
inclusion/exclusion criteria for the HSC will need to be respected, reliable
senior supportpresent at all times (additional staff ?, more help from the
consultant on-call) and properdocumentation of the follow-up and discharge
plan will all contribute to better outcomes for the HSC patients. Also adherence
to the current pathways and development of local guidelines to manage the most
common conditions would be of great help.
To summarise, introduction of the updated guidelines/pathways as
recommended by the RCS and ASGBI will seek to improve the management of
the surgical patients in HSC in a more effective manner.