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Achieving standards for unscheduled surgical care

Kirsten McArdle (Sandwell West Birmingham NHS Trust, Birmingham, UK)
Edmund Leung (Department of Surgery, Shrewsbury and Telford NHS Trust, Shropshire, UK)
Neil Cruickshank (Sandwell West Birmingham NHS Trust, West Bromwich, UK)
Veronique Laloe (Good Hope Hospital Heart of England NHS Trust, Sutton Coldfield, UK)

Clinical Governance: An International Journal

ISSN: 1477-7274

Article publication date: 1 January 2014

217

Abstract

Purpose

The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations.

Design/methodology/approach

A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines.

Findings

A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate >5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission.

Originality/value

To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.

Keywords

Citation

McArdle, K., Leung, E., Cruickshank, N. and Laloe, V. (2014), "Achieving standards for unscheduled surgical care", Clinical Governance: An International Journal, Vol. 19 No. 1, pp. 21-29. https://doi.org/10.1108/CGIJ-07-2013-0019

Publisher

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Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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