WHAT IS THE REQUIREMENT FOR OUT-OF-HOURS OPERATING IN ORTHOPEDICS

Recent reports have emphasized the need to reduce the amount of unsupe rvised surgery performed at night by junior doctors. However there is little guidance about when an operation must be performed urgently and when it can be postponed safely. This study describes the existing pa ttern of out-of-hours trauma and orthopaedic surgery in four hospitals and reports the views of a panel of surgeons and anaesthetists on the extent to which operating could be postponed until the following day. Operations at night are uncommon - a mean of 0.6 per night and occurr ing on only 40% of nights - though their frequency shows two-fold vari ation between hospitals. With certain assumptions it is estimated that up to a third of out-of-hours operations could be postponed safely to the following day. Further evaluation is required of those operations about which the panel failed to reach agreement. While most of the pr ocedures undertaken at night are within the competence of a registrar, some require the direct involvement of a consultant.