Case Study

Trauma Ambulatory Care Unit (TACU)

The new patient pathway saved TACU 66 bed days per month providing the health board with a saving of £1,000,000 over a 2.5 year period.

Brief

Prior to the establishment of the Trauma Ambulatory Care Unit (TACU) ambulatory trauma patients were treated through the Emergency Department stream. The existing pathways for non-complicated trauma patients treated in the hospital was based on a historical standard of care, relying on the availability of beds to provide treatment but the beds were often filled with non-ambulant or systemically unwell patients.

The unsuitable environment of no access to a bed, natural light, or refreshments meant the overall patient experience was poor. Feedback was that the area was uncomfortable and detracted from their clinical care. Patients often self-discharged against medical advice directly citing the poor facilities. This in turn compromised their care leading to worse outcomes.

Approach

As patient concerns became apparent, the need for an alternative was clear: A facility that could host in-patients, administer care, without the need for an in-patient bed, allow senior medical review, and escalate care to the operating theatre as needed.

To solve this problem the health board introduced TACU and reproduced best practice examples from ambulatory care by streamlining appropriate patients into an ambulatory care pathway, alongside a behavioural mindset change of clinicians to be more “why can’t this be day case?” versus “can this be day case?” This mindset change prompted a fundamental new approach.

The health board and Ocura worked together to select 8 new recliners. Mauro, a compact recliner was selected, allowing patients to have their consultation, treatment, and recovery in one chair. For minor surgery, Verona was selected enabling maximum clinical flexibility.

Outcome

Simple minor procedures can be performed within the unit itself and when necessary, patients are prepped for theatre and can recover in TACU post-operatively before discharge the same day.

Patients requiring intravenous antibiotics over many days are now attending day visits, the patient can be kept on the antibiotics for the full term without using bed space, resulting in better care for patients.

Patient feedback is universally positive, 82% of patients rated the new facility as “excellent” on a 5‑point scale and stated they enjoy the flexibility that the unit offers.

Better patient outcomes and satisfaction

Before TACU patients coming in via the Emergency Department would have followed the following pathway:

Emergency Department (including Triage)
Waiting for bed availability
Overnight stay
Pre-op, surgery
Post-op recovery
Antibiotic infusions
Discharge

New patient TACU pathway:

Emergency Department (including triage)
Referred to TACU
Wound accessed and dressed
Pre-op
Surgery
Post-op recovery
Antibiotic infusions

Based on a total dataset of 76,265 cases from February 2013 to 15^th January 2023 the following was measured pre and post TACU.

For open reduction and fixation surgery:

Pre-TACU average LOS was 87 hours

Post-TACU average LOS is 12 hours

Continuous IV Abx:

Pre-TACU average LOS was 60 hours

Post-TACU average LOS is 47 hours

More Beds for those who need them

A key outcome is that by freeing up these beds, there are more beds available for patients coming in through the Emergency Department, who do need to be admitted. Now only 7% of patients end up requiring a hospital bed overnight.

Staff Wellbeing & Retention

The unit runs with minimal staff: 1 qualified and 1 non-qualified nurse covering the 8 chair spaces. Recruitment was easy, the staff like the predictable hours and place of work and the unit takes up a small geographical space.