CAN EMERGENCY GENERAL SURGICAL REFERRALS BE REDUCED - A PROSPECTIVE-STUDY

It has been proposed that early assessment by a senior surgeon would r esult in a significant reduction in the number of general surgical adm issions.' A prospective study of 290 surgical patients admitted to a b usy district general hospital over a period of 1 calendar month has be en performed to test this hypothesis. After admission, all patients we re assessed by a senior surgeon who carried out triage for each patien t. The commonest diagnoses in descending order of frequency were non-s pecific abdominal pain, appendicitis, diverticular disease, cholecysti tis, head injury and pancreatitis. Twenty-two per cent of emergency ad missions underwent emergency surgery. A total of 90.7% of admissions w ere deemed appropriate, 5.5% were deemed inappropriate and in 3.8% of cases the senior surgeon was uncertain as to whether the patient shoul d be admitted or not. Our data fail to substantiate the claim that a s ignificant reduction in intake size would be achieved by early assessm ent by a senior surgeon. Assessment by surgeons may mean sacrificing o ther clinical commitments, and is likely to result in a diminution in the standard of both basic and higher surgical training.