ANZ J. Surg. 2004; 74: 346–349 ORIGINAL ARTICLE ORIGINAL ARTICLE EVALUATION OF LEVEL 1 CARE FACILITIES FOR VASCULAR PATIENTS MICHAEL G. A. NORWOOD,*‡ MATTHEW J. BOWN,*‡ PETER R. F. BELL,‡ PAUL SPIERS,† APSARA LESLIE† AND ROBERT D. SAYERS*‡ *Departments of Surgery, and †Anaesthetics and Critical Care, Leicester General Hospital; and ‡Department of Surgery, University of Leicester, Leicester, England, UK Background: A surgical acute care unit (SACU) was established within our hospital to specifically provide level 1 care to surgical patients. We assess the impact that this has had on outcome in vascular patients. Methods: All patients undergoing carotid endarterectomy (CEA) and elective abdominal aortic aneurysm repair (AAA) during the first year of SACU were included in the present study. A control group was compiled from patients undergoing the same two procedures in the year preceding the opening of the SACU. Data were collected on admission time, time spent in critical care, outcome and operative cancellations. Results: During the first year of the SACU there were 28 CEA and 42 AAA repairs performed. In the control group there were 18 CEA and 34 AAA repairs performed. There were no significant differences in death rate or length of hospital stay between the two groups for either AAA repair or CEA. CEA patients in the study group had a significantly reduced level 2 stay ( P < 0.001 Mann–Whitney U -test), with 71% of patients being admitted directly to the level 1 facility from theatre. There were less CEA can- celled because of critical care bed shortages among the cases ( n = 0) compared to the control group ( n = 2), although this did not reach statistical significance ( P = 0.15 Fisher’s exact test). Conclusions: Designated level 1 care has reduced the need for the postoperative admission of CEA patients to level 2 care facili- ties. It has had no discernible impact on admission time or mortality, but might reduce the number of cancelled operations caused by a lack of level 2 beds. Key words: postoperative care, vascular surgical procedure. Abbreviations: AAA, abdominal aortic aneurysm; CEA, carotid endarterectomy; HDU, high dependency unit; IQR, inter- quartile range; ITU, intensive care unit; LGH, Leicester General Hospital; SACU, surgical acute care unit. INTRODUCTION The surgical acute care unit (SACU) was established as a level 1 care facility at the Leicester General Hospital (Leicester, Eng- land, UK) in June 2001, with the aim of bridging the gap between the degree of care received in the high dependency unit (HDU), and the care received on the general surgical and medical wards. This was in response to a report published in May 2000 by the UK’s Department of Health Expert Group, on its review of adult critical care services in England. 1 In the report, they define four levels of patient care (Table 1), which hospitals should provide to meet the needs of each individual patient. Level 0 corresponds to an acute surgical ward, level 2 to high dependency care and level 3 to intensive care (ITU). Currently in the majority of UK hospi- tals, there are no designated units specifically designed for the provision of level 1 care. The Leicester General Hospital (LGH) is one of three acute teaching hospitals in Leicester. These hospitals jointly serve a population of 960 000. Within LGH, there are 83 acute surgical beds including 16 vascular beds (44 in total between all the Leicester hospitals), four HDU beds, eight ITU beds and four SACU beds designed to provide level 1 care. Other departments include urology, nephrology (including a renal HDU), renal transplant surgery and cardiology (including a cardiac care unit). The SACU was opened in a single bay of an acute surgical ward, which previously accommodated six patients. At each bed, there is equipment available for continuous electrocardiography, oxygen saturation, central venous pressure and intra-arterial pressure monitoring. Epidural anaesthesia is also used routinely. The SACU is run as a separate unit to the rest of the ward, with its own team of nurses, providing a minimum required staff to patient ratio of one nurse per three patients. These nurses are not required to have had specialist ITU/HDU training, but do receive instruction in the care and monitoring of critically ill patients in the form of a 2 week course. There is also formal support and teaching provided by the hospital’s ITU outreach service. Now that SACU and the provision of level 1 has been in exist- ence for one year, the aim of the present study is to assess the impact in terms of outcome, that SACU has had on the patients that have been through the system, with specific reference to vas- cular patients. METHODS For the first year of SACU (4 June 2001–4 June 2002), all vascu- lar patients undergoing abdominal aortic aneurysm repair (AAA) M. G. A. Norwood MBChB, MRCS(Lon); M. J. Bown MBChB, MRCS(Lon); P. R. F. Bell MD, FRCS; P. Spiers MBChB, FRCA; A. Leslie MBChB, FRCA; R. D. Sayers MD, FRCS. Correspondence: Mr M. Norwood, Department of Surgery, The Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, England, UK. Email: drmikenorwood@hotmail.com Accepted for publication 19 November 2003.