The neurosurgeon on duty -- quality and quantity of acute care

An important part of the daily routine in neurosurgery is the treatment of emergency room admissions, acute cases from other departments or from outside hospitals. This acute care is not normally included in performance figures or budget management nor analysed scientifically with respect to quantity and quality of care provided by neurosurgeons.

Over a one-year period, all acute care cases managed by two neurosurgical on-call teams in Hannover (Northern Germany, 522 000 inhabitants) were recorded prospectively on a day-by-day basis. A large database of 1 819 entries was created and analysed using descriptive statistics.

The minimum incidence of neurosurgical acute care cases was estimated to be 75-115/100 000 inhabitants/year. This corresponds to a mean of approximately 6 per day. The majority of patients was admitted after 5 p. m. and on weekends. Only 30 % of cases came directly via the emergency room. The fate of 70 % of patients depended initially on the "neurosurgical qualification" of primary care doctors and here deficits existed. Over one year the additional workload from acute care amounted to 1 000 unplanned admissions, 900 acute imaging procedures and almost 600 emergency operations.

The current policy in public health which includes cuts in resources, transport facilities and manpower is not compatible with the demonstrated extent of acute neurosurgical care. In addition to routine elective work, a high number of extra admissions, evening or night-time surgery, and imaging procedures has to be carried out. These conclusions hold a special importance if health authorities wish to not just maintain present standards but to improve existing deficits.