Separating elective and emergency surgical care (the emergency team)

The purpose of this study was to evaluate the influence on general surgical activity following the separation of elective from emergency, surgical car e in one large teaching hospital. A prospective audit of elective and emerg ency general surgical activin. between 1994 and 1999 inclusive was carried out. Elective and emergency surgical activity was separated in January 1996 , with a dedicated 'Emergency Team' of one consultant for one week, two reg istrars, two senior house officers and four house officers for two weeks, i n addition to a 20 bed acute admission ward and a 24 hour emergency theatre . The consultant cancelled the majority of his/her elective work during the on-call week. A prospective collection was made of all elective and emerge ncy operations carried out between 1994 and 1999 during the Lothian Surgica l Audit system. Out of hours operative activity was analysed retrospectivel y from data collected using the Operating Room Schedule of Surgery (ORSOS) and outpatient clinic and day case activity collected from the Hospital Adm inistration System. Comparisons were made between years 1994/1995 and 1966/ 7/8/9. Emergency surgical admissions rose by 86% from 1973 patients in 1994 to 3675 in 1999. During the same period, elective in-patient activity rema ined fairly steady, but there was an increase in day surgery from 469 to 20 89 cases per annum. Despite the on-call consultant cancelling his/her outpa tient clinical, overall outpatient activity also increased from 9911 to 123 35. However a proportion of this reflects the appointment of two new consul tants in April 1998. Emergency operations increased from 941 in 1994 to 135 1 in 1999. with a two-fold reduction in operations carried out between 0000 -0800 hours from 16% in 1994 to 7.9% in 1999. A separate and dedicated 'Eme rgency Team 'is an efficient method of managing acute general surgical admi ssions. It permits elective work to carried on uninterrupted, reduces the n umber of operations performed after midnight, and provides a better environ ment for teaching and training. This scenario might also be applicable to o ther medical specialties who have a large emergency committment.