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PWE-416 Does a general surgery dual-specialty consultant on-call system improve emergency access to appropriate specialist surgery?
  1. GC Kirby,
  2. A Torrance,
  3. RPT Evans
  1. General Surgery, Royal Stoke University Hospital, Stoke on Trent, UK

Abstract

Introduction Subspecialisation within general surgery has resulted in concerns over the provision of emergency surgical care. Outcomes after some elective surgery have been shown to be better when performed by a surgeons of an appropriate subspeciality.1Some advocate emergency surgery should be considered in the same way, and performed by appropriately trained specialists. A dual consultant on-call system has been proposed as a means of ensuring this occur. This study aims to identify whether patients receive subspecialty emergency surgical intervention using an in-hours dual consultant on-call system.

Method A prospective review of all emergency laparotomies performed at a single centre from 11/01/2014 to 12/01/2015. Data was collected on indication for surgery, operative findings, subspecialty interest of operating surgeon, and the timeliness of surgery compared to CEPOD operative urgency grading. Operations were classified as General: suitable for any surgeon (GEN); Upper Gastrointestinal (UGI); and Colorectal (COL). Our centre operated a dual consultant on call system within normal working hours, and single consultant outside hours.

Results 306 emergency laparotomies were identified. 169 (55%) were classified as GEN; 22 (7%), UGI; 115 (38%), COL by procedure. The most senior surgeon present was consultant in 281 (92%) of cases, Specialist Trainee in 24 (8%), and unknown in 1. (36) 12% of cases were due to a complication of previous surgery. 20% of cases were performed out-of-hours.

Within normal working hours, 90 of 103 (87.4%) operations of a specialist nature were performed by a consultant surgeon of that specialty. Outside of these hours, this figure was 15 out of 27 (55.6%). 95% of cases were performed within the NCEPOD operative timing classification.

Conclusion A dual consultant on-call system does result in the majority of patients receiving emergency care by a surgeon with the appropriate subspeciality interest, and allows this to occur in a timely fashion.

Disclosure of interest None Declared.

Reference

  1. Anwar S, Fraser S, Hill J. Surgical specialization and training – its relation to clinical outcome for colorectal cancer surgery. J Eval Clin Pract. 2012 Feb;18(1):5–11

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