Optimising Patient Flow: Reducing Length of Stay in the Gynaecology Ambulatory Unit

By Dr. Rayma Camacho-Risquet, Dr Kageena Selvarajah, Dr Nida Ibrahim, Ms Manjula Raajkumar Newham University Hospital Objective:

 

The Gynaecology Ambulatory Unit (GAU) provides same-day procedures and treatments without the need for overnight stays. Open daily from 8 AM to 8 PM, it combines “see and treat” care with rapid access to diagnostics, surgery, and follow-up. This model supports the NHS 2022/23 Delivery Plan by reducing inpatient admissions and improving wait times. While the target is to complete care within 4 hours, this is not always met. Design: This study is a quality improvement (QI) project, was conducted at a district general hospital serving a socioeconomically diverse population. It reviewed patient records over a one-month period to evaluate the length of stay in GAU, the clarity of the admission reason, and the availability of preordered prescriptions to reduce waiting times.

Methods: Data were collected from electronic records of all patients attending GAU from 01/11/2024 to 30/11/2024 (1 st cycle) and 01/02/2025 to 28/02/2025 2 nd cycle The study assessed: 1. The duration patients were reviewed and discharged. 2. If the patients were correctly booked for an appointment 3. If needed- were medications pre-ordered Results:  Mean length of Stay in both cycles - November: 5h 36mins - February 5h 12mins Range of Stay: November 2024: Minimum: 44 minutes Maximum: 13hours February 2025 Minimum: 27 minutes  Maximum: 11.3 hours ⏱ Patients Discharged in Under 4 Hours November 2024: 25.8% (30 patients) February 2025: 35.1 % (26 patients) Conclusion: Cycle 1: 74.1% of patients stayed longer than necessary Cycle 2: Reduced to 64.8%, with delays from late reviews and treatment waits Improvements:  >10% increase in correct GAU bookings 24% increase in pre-ordered meds 10% more patients discharged within 4 hours However:  Mean stay still > 4 hours Next Steps: Boost staffing to improve reviews and treatment times 01 November 2024- 30 November 2024 01 February 2025 – 28 February 2025 Total number of patients 116 106 Patients correctly booked on CRS 61.2 % (n=71) 71.7% (n=30) Patients with pre-ordered medications when applicable 9.09 % (n=2/22) 33.3 % 7/21 Change implemented: GAU Process Update A new GAU booking flowchart was shared with the O&G team (Dec–Jan).

Target stay: ≤ 4 hours (excluding surgical day cases). Surgical cases are managed via CEPOD by urgency, not arrival time. References: gynaecology-elective-care-handbook.pdf GAU Appointment reasons in November 2024 GAU Appointment reasons in February 202