Emergency general surgery: a ‘state of the nation’ survey

Abstract

Many projects seek to improve emergency general surgery (EGS) care across England. However, no study to date has examined how EGS is currently organised or how this is evolving. The aim of this study was to determine the current status of EGS organisation in England, whether this correlates with measures of hospital activity and changes proposed in the future. Surveys were sent to all NHS trusts in England via freedom of information requests. Trusts were given eight weeks to reply. Trust characteristics were ascertained by asking their organisational structure as well as acute bed numbers, number of admissions under general surgery, number of cases submitted to the National Emergency Laparotomy Audit in 2021 and whether they planned to start an EGS service within the next five years. Organisational structures were categorised as: a) mixed general surgical take; b) daily allocation to a subspecialty; c) dedicated EGS consultants/service covering weekdays; d) dedicated EGS consultants/service covering weekdays and weekends; or e) other. A total of 101 organisations responded. There were 36 organisations in group A, 16 in group B, 10 in group C, 30 in group D and 5 in group E. Four organisations declined to supply information on organisational structure. No trust characteristic was significantly different between organisational structures. Two-fifths (41%) of the organisations reported having an EGS service in place (groups C and D). Almost a quarter (23%) of those without an EGS service reported plans to implement one within the next five years. Our results indicate a growing trend towards implementing EGS services in England, with over 50% of trusts expected to offer such a service in five years’ time. It is important to pursue a collaborative definition of best practice for EGS to ensure high quality care for patients.