Morning or afternoon emergency list? Effects on service provision and training

In response to the recommendations of the National Confidential Enquiries into Perioperative Deaths many UK hospitals have introduced a half day (morning or afternoon) planned list for emergencies. We have compared two district general hospitals (DGH A and DGH B) within the same Trust with an afternoon and a morning list, respectively, and examine whether there is any effect on the emergency and urgent laparotomy workload.

We conducted a retrospective comparative audit of emergency and urgent laparotomies performed in a six-month period at the two hospitals. The chi-square test was used for statistical analysis.

In DGH A and DGH B, 79 and 73 laparotomies were performed, with 18% and 22% mortality, respectively, (p=0.609). The median age was 74 (18-93) years and 67 (12-92) years and the median postoperative stay was 12 (1-149) days and 14 (4-74) days, respectively. 59 laparotomies were performed during weekdays in DGH A and 51 in DGH B. There was no difference between hospitals in the seniority of the operating surgeon or the level of supervision. DGH A accommodated 24% of its laparotomies on the afternoon emergency list, 39% on elective lists, 29% in the evening, and 8% at night. DGH B accommodated 33% of its laparotomies on the morning emergency list, 8% on elective lists (p=0.001), 51% in the evening (p=0.063), and 8% at night. Overall 63% of laparotomies in DGH A and 41% in DGH B were done during daytime.

Less than one-third of laparotomies were performed on the emergency list, suggesting underutilisation. The seniority of the surgeon and the level of supervision were similar at both sites. Neither morning nor afternoon proved better in terms of service provision or training opportunities. By accommodating laparotomies onto an elective list DGH A reduced the number of laparotomies performed in the evening.