Defining minimum work priorities in emergency general surgery in a national cohort.

Abstract

Introduction: Emergency general surgery is typically delivered in addition to routine elective care. Models such as acute surgical assessment units and reduced elective working have been explored to reduce the conflict between these competing demands. We aim to identify the models used, the cohorts of patients seen, and the staffing levels in each system.

Methods: Data on general surgery activities were obtained from the National Quality Assurance and Improvement System (NQAIS) and previously published data. The mode of delivery of acute services in other countries was collated from national surgical bodies and published position statements.

Results: National on-call services are supra-elective or parallel to elective streams with little dedicated on-call. Internationally, many similar countries are moving to separate acute and elective care to ensure both are performing optimally. Staff in Model 3 hospitals are frequently on call with variable but small operative numbers but represent a combination of high and low acuity. These consultants need a wider breadth of surgical skills than Model 4 hospitals due to a lack of local specialists.

Conclusion: The majority of national hospitals still work a traditional on-call model, with limited adoption of separate on-call and elective workstreams. Preserving the elective workload is likely to require separation of these priorities, which is difficult with current staffing levels. The use of Acute Surgical Assessment Units (ASAUs) within emergency surgical networks may improve patient outcomes by regionalising the delivery of higher acuity care.