Background
Referrals for Plastic Surgery trauma cases are increasing. Additionally, there is more pressure on all acute hospital services, especially the Emergency Department, so streamlining departmental service provision is crucial. Most plastics referrals are brought to ED to be seen the same day, resulting in long waiting times and increasing numbers of patients being seen out of hours. HAPI clinic was introduced to direct flow of patients away from ED and into a clinic setting for timely evaluation and management during daytime hours.
Following the successful trial of HAPI clinic, we are conducting prospective analysis over 6 months to further evaluate the positive impact of HAPI clinic on acute patient flow.
Methods
Over six weeks, 106 patients were seen in HAPI clinic. Comparative analysis examined time from referral to appointment, time to treatment and location of treatment. We also compared February-March 2023 ED attendances and average ED waiting times and acute admissions to plastic surgery ward to the same time period in 2024, following the introduction to HAPI clinic
Results
Of 106 patients seen through HAPI clinic 97% of open injuries received treatment within 24 hours of their appointment, 90% being the same day as their appointment. Average wait for an appointment was 0.89 days for open injuries and 1.06 days for closed injuries.
Introduction of HAPI clinic was associated with a 30% decrease in acute admissions and 29% reduction in attendances to ED for plastics patients with 25% reduction in patients waiting over 6 hours to be seen. Additionally HAPI clinic resulted in reduced trainee fatigue and improved training opportunities for junior staff.
Conclusions
Introduction of HAPI clinic has been associated with reduction in acute admissions, ED attendances and wait times. It’s an efficient, effective and safe method of directing acute patient flow through a Plastic Surgery Department.