Evaluation of an ambulatory abscess pathway in a district general hospital and the impact of COVID on ensuring long term compliance.

Abstract

Introduction

Superficial skin abscesses are common and can lead to significant illness if not managed promptly. The gold standard treatment is incision and drainage (I&D), as, often antibiotics alone do not lead to resolution. This multi-cycle retrospective study audits the practice in a district general hospital by assessing the efficiency of a day case abscess pathway. 

Methods

Phase 1 established standards for creating the pathway by streamlining patients to be operated on dedicated days, phase 2 evaluated the effect on waiting times for I&D, and phase 3 assessed the efficacy of the pathway after the impact of COVID. Data collected includes gender, age, comorbidities,  time of admission to the surgical assessment unit, time sent for by theatre, anaesthetic agent, and discharge date.

Results

Phase 1 was conducted from 2017 to 2018, included 87 cases, and the average wait time was 8 hours 29 minutes for I&D. Phase 2 included 32 cases from August to October 2019, showed an average wait of 4 hours 43 minutes with 2 patients requiring overnight admission.  Phase 3 included 208 patients from January to December 2022, showed an average wait of 4 hours 55 minutes with 21% requiring an unplanned overnight admission.

Conclusion

This study showed that there is significant benefit of a day case abscess pathway. It leads to fewer admissions, improving patient satisfaction and saving money for hospital trusts. There needs to be strict criteria to ensure that appropriate patients are triaged to them. This will require ongoing refinement and both medical and nursing staff education.