Surgical Assessment Units, while a good idea in theory, are hindered by too much reliance on doctors, argues Alison Rae
Surgical Assessment Units (SAUs) have been introduced into acute trusts across the South-East of England over recent years as a way of reducing pressure on accident and emergency departments.
Patients with acute surgical problems including appendicitis, cholecystitis and pancreatitis, are generally referred to an SAU by their general practitioner, A&E staff or by outpatient clinics.
When they arrive, patients are triaged by a surgically trained nurse who will record vital signs, gain intravenous access and take bloods if necessary. They then have to wait to be seen by the surgical doctor on call, just as they would if they had attended the accident and emergency department.
In reality the wait to be seen by the on call surgical doctor may be prolonged as they are expected to review patients on the wards and in A&E, as well as SAU.
”Nurses working in SAU are generally very knowledgeable and experienced and can usually pre-determine at triage what diagnostic tests a patient needs”
This extended waiting time can lead to increased patient anxiety as well as verbal and written complaints. This is hugely frustrating because surgical nurses working in SAU are generally very knowledgeable and experienced and can usually pre-determine at triage what diagnostic tests a patient needs, for example patients referred with possible appendicitis will require an ultrasound scan to determine the underlying cause of their symptoms. However SAU nurses do not currently have the competencies or autonomy to physically examine patients or request these tests before the patient has been seen by a doctor.
One way to address this issue would be to recognise the value and experience of the senior nurses working in SAU by introducing an Advanced Nurse Practitioner (ANP) role. The vision is that ANPs working on SAU could be empowered to demonstrate the skills and competencies necessary to physically examine patients at the point of triage and, under locally agreed protocols, determine an appropriate treatment plan and request the necessary diagnostic investigations needed to reach a provisional diagnosis. This extended role will also include the ability to prescribe pain relief and intravenous fluids where necessary.
”ANPs could reduce waiting times for patients attending SAU”
Ultimately, ANPs could reduce waiting times for patients attending SAU thus reducing complaints and improving the patient experience.
Arguably there are already ANPs working in minor injury units and A&E departments who could share their competencies and experience in practice to help develop this role. ANPs could provide a far more holistic patient focused service as they would be solely based on SAU and they would also help to reduce the workload of the surgical on call teams.
”I can’t help thinking we could make this even better by enabling nurses to develop their skills”
When I hear of SAUs and the good work they do to reduce the pressure in A&Es I can’t help thinking we could make this even better by enabling nurses to develop their skills and help patients to receive the care they need in a timelier manner.
Without a shared vision, SAUs will become stagnant and their success will remain wholly dependent upon doctors being readily available to review patients, which we know they are not. In reality acute trusts are become busier and we must find new ways of working to ensure that we provide the best care for our patients.
Alison Rae is a senior lecturer in adult nursing and paramedic science, University of Greenwich