Air ambulance retrievals of patients with suspected appendicitis and acute abdominal pain: The patients’ journeys, referral pathways and appendectomy outcomes using linked data in Central Queensland, Australia

Abstract

Introduction

Acute appendicitis is the most common cause of acute abdominal pain presentations to the ED and common air ambulance transfer. Aims: describe how linked data can be used to explore patients’ journeys, referral pathways and request-to-activation responsiveness of patients’ appendectomy outcomes (minor vs major complexity).

Methods

Data sources were linked: aeromedical, hospital and death. Request-to-activation intervals showed strong right-tailed skewness. Quantile regression examined whether the longest request-to-activation intervals were associated with appendicitis complexity in patients who underwent an appendectomy.

Results

There were 684 patients in three referral pathways based on hospital capability levels. In total, 5.6 % patients were discharged from ED. 83.3 % of all rural origins entered via the ED. 3.8 % of appendicitis patients were triaged to tertiary hospitals. Appendectomy patients with major complexity outcomes were less likely to have longer request-to-activation wait times & had longer lengths of stay than patients with minor complexity outcomes.

Conclusions

Linked data highlighted four aspects of a functioning referral system: appendectomy outcomes of major complexity were less likely to have longer request-to-activation intervals compared to minor (sicker patients were identified); few were discharged from EDs (validated transfer); few were triaged to tertiary hospitals (appropriate level for need), and no deaths relating to appendectomy.