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.
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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