{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:32:43Z","timestamp":1789047163091,"version":"build-2803163510"},"reference-count":17,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000345","name":"Association of Surgeons of Great Britain and Ireland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000345","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010311","name":"Guts UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010311","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MRC","award":["MR\/S001751\/1"],"award-info":[{"award-number":["MR\/S001751\/1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,21]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Ambulatory care is defined as the provision of medical treatment by healthcare professionals outside an inpatient hospital setting. While well-established in acute medicine, uptake of ambulatory pathways in emergency general surgery (EGS) is variable and optimal design and delivery is unclear in this context. This systematic review sought to (1) appraise current EGS ambulatory pathway literature and (2) ascertain the constituent components across the identified pathways, guiding the development of comprehensive templates for future EGS ambulatory pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Embase, Medline and Cochrane Library, from 5 December 2018 to 5 December 2023 inclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>All primary observational studies (ie, case\u2013control, cohort studies and randomised controlled trials (RCTs)) were included. Case series and conference abstracts were excluded due to the high likelihood of incomplete data. Studies reporting paediatric or non-surgical populations, or ambulatory surgical care within a primary care setting, were also excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>General study characteristics (year and journal of publication, country of origin, study design, disease area, number of patients receiving ambulatory management and use of control groups) were recorded. To identify the constituent components of EGS ambulatory pathways, an initial subset of five papers was reviewed, from which four categories were identified (decision-making processes, scoring\/classification systems, investigations and care escalation and discharge criteria). An additional fifth component (\u2018follow-up\u2019) was identified during data extraction. Reporting of the constituent components of ambulatory pathways was also extracted, as well as outcomes including readmission, complications and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 43 included studies, there were 8 RCTs, 31 cohort studies and 4 studies using other methods. Reporting of all aspects of EGS ambulatory pathways was heterogeneous. 24 (56%) papers reported the specialty and grade of clinician acting as senior decision-maker. 17 different scoring\/classification systems were used. 32 (74%) papers described using investigations to select ambulatory patients, including blood tests (n=12) and imaging (n=16). Eight studies (19%) specified both care escalation and discharge criteria. Information about follow-up was described in 29 papers, with location (n=29), time points (n=26), personnel (n=16) and the form of the follow-up (n=23) all reported variably. Readmission rates were recorded in 34 studies and ranged from 0% to 13%. Most studies (n=32) reported 30-day readmission, although 48 hours (n=1) and 90 days (n=1) were also used. Mortality was recorded in 24 papers, with 21 reporting a mortality rate of 0 and the remaining 3 reporting rates of &lt;0.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Key components of published EGS ambulatory pathways include decision-making processes, scoring\/classification systems, investigations, care escalation and discharge criteria, and follow-up. However, this information is currently inconsistently reported. Future work to identify and agree on guidelines for the \u2018core\u2019 components of ambulatory EGS pathways is needed, to facilitate cross-study comparisons, and crucially, provide a \u2018gold-standard\u2019 framework for developing future ambulatory pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099203","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T07:20:29Z","timestamp":1759130429000},"page":"e099203","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Use of ambulatory pathways in emergency general surgery: a systematic review"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2949-6236","authenticated-orcid":false,"given":"Benjamin","family":"Fox","sequence":"first","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Walters","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"Mid Yorkshire Hospitals NHS Trust, Wakefield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Pathak","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-5314","authenticated-orcid":false,"given":"Adam","family":"Peckham-Cooper","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie S","family":"Blencowe","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"Centre for Surgical Research, Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"2026052205350528000_15.9.e099203.1","unstructured":"Ambulatory care | agency for healthcare research and quality [internet]. 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Br J Surg 2021;108. doi:10.1093\/bjs\/znab430.069","DOI":"10.1093\/bjs\/znab430.069"},{"key":"2026052205350528000_15.9.e099203.5","unstructured":"NHS England . Getting it right first time: principles for acute patient care. 2024. Available: https:\/\/gettingitrightfirsttime.co.uk\/girft-issues-principles-to-improve-the-flow-and-experience-of-patients-through-urgent-and-emergency-care\/ [Accessed 19 Aug 2024]."},{"key":"2026052205350528000_15.9.e099203.6","first-page":"49","article-title":"Reflections on ambulatory pathways in the post-covid era","volume":"1","author":"Menon","year":"2020","journal-title":"Ambul Surg"},{"key":"2026052205350528000_15.9.e099203.7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7861\/clinmedicine.18-1-69","article-title":"Ambulatory emergency care - improvement by design","volume":"18","author":"Hamad","year":"2018","journal-title":"Clin Med (Lond)"},{"key":"2026052205350528000_15.9.e099203.8","unstructured":"Anderson I . The future of emergency general surgery: a joint document key recommendations. 2015."},{"key":"2026052205350528000_15.9.e099203.9","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1308\/rcsann.2019.0061","article-title":"Enhancing the emergency general surgical service: an example of the aggregation of marginal gains","volume":"101","author":"Panagiotopoulou","year":"2019","journal-title":"Ann R Coll Surg Engl"},{"key":"2026052205350528000_15.9.e099203.10","first-page":"501","article-title":"Providing safe and effective surgical care during the COVID-19 outbreak in the UK - changing strategies","volume":"9","author":"Chapman","year":"2020","journal-title":"Int J Health Policy Manag"},{"key":"2026052205350528000_15.9.e099203.11","doi-asserted-by":"crossref","unstructured":"Page MJ , McKenzie JE , Bossuyt PM , et al . The prisma 2020 statement: an updated guideline for reporting systematic reviews. n.d.","DOI":"10.31222\/osf.io\/v7gm2_v1"},{"key":"2026052205350528000_15.9.e099203.12","doi-asserted-by":"crossref","unstructured":"Ouzzani M , Hammady H , Fedorowicz Z , et al . Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016;5. doi:10.1186\/s13643-016-0384-4","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2026052205350528000_15.9.e099203.13","unstructured":"Collaboration C . RoB 2: a revised Cochrane risk-of-bias tool for randomized trials | Cochrane Bias. Br Med J 2022;1\u201324."},{"key":"2026052205350528000_15.9.e099203.14","unstructured":"Tian Y , Dixon A , Gao H . Emergency hospital admissions for ambulatory care-sensitive conditions: identifying the potential for reductions. The King\u2019s Fund 2012."},{"key":"2026052205350528000_15.9.e099203.15","unstructured":"NHS England . SAMEDAY strategy. 2024. Available: https:\/\/www.england.nhs.uk\/long-read\/sameday-strategy\/ [Accessed 20 Jun 2024]."},{"key":"2026052205350528000_15.9.e099203.16","doi-asserted-by":"crossref","first-page":"425","DOI":"10.20344\/amp.10416","article-title":"Quality indicators in ambulatory surgery: a literature review comparing portuguese and international systems","volume":"31","author":"Nunes","year":"2018","journal-title":"Acta Med Port"},{"key":"2026052205350528000_15.9.e099203.17","unstructured":"NHS England . Emergency care data set v 2.1 [internet]. 2015. 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