Acute Abdominal Pain Pathway - General Surgery
Within 30 minutes of arrival:
Record EWS and follow EWS algorithm
Does patient require urgent resuscitation or immediate surgery? (or EWS > 3)
Within 90 minutes of arrival:
EWS > 3
Inform Senior Doctor on Ward/ED
Call Surgery Middle Grade (BLP 903)
If not attending within 30 mins
escalate to Consultant on Call 
Ensure patient has:
- IV Access (2 recommended)
- Urinary Catheter (if appropriate)
- FBC/U&E/LFT/Clotting Studies
- G&S/X-Match (as appropriate)
- Imaging (CT/US on way to theatre if appropriate)
- Venous or arterial gas inc. lactate
- Warfarin history taken
Surgeon consults with Anaesthetist
Discuss with Critical Care
Does patient require HDU/CU/Surgical High Care?
Yes - Transfer to relevant Critical Care area
No - Theatre available?
Yes - Transfer to Theatre
No - Transfer to Theatre Resuscitation for recovery
EWS 0 - 1
9am - 5pm Mon - Fri?
Telephone Surgical Rapid Access Clinic (SRAC) 7810 (BLP 067) to speak to Surgical Middle Grade for urgent clinic slot
SRAC Slot available?
Yes
Surgical Middle Grade in SRAC reviews patient and makes a primary assessment and provisional diagnosis
No
Admit to SAU
- Senior review
- Complete Surgical – Unplanned Admission Document
- Ensure Management plan clearly documented in notes
Arrange Further investigations (if required)
Arrange Surgical Outpatient Appointment
Review patient in SARC next day and results of investigations (if required)
Discharge SAU
Decision to admit?
Yes
Admit to SAU
- Senior review
- Complete Surgical – Unplanned Admission Document
- Ensure Management plan clearly documented in notes
No
Arrange Surgical Outpatient Appointment
EWS 2 - 3
Admit to SAU
- Senior review
- Complete Surgical – Unplanned Admission Document
- Ensure Management plan clearly documented in notes
Arrange Further investigations (if required)
Arrange Surgical Outpatient Appointment
Review patient in SARC next day and results of investigations (if required)
Discharge SAU
Conservative OR Operative management?
CONSERVATIVE
Prescribe and initiate medications (e.g. antibiotics, pain relief)
Discharge to Primary Care
OPERATIVE
Contact waiting list
List for operation with current surgeon of the week
Discharge home