Which general surgical operations must be done at night?

Area of Science:

• Medical Staffing
• Surgical Workload Management
• Patient Safety

Background:

• Increasing concerns regarding hospital medical staffing during the 1980s.
• Potential impact of "Achieving a Balance" policy on registrar numbers and consultant out-of-hours work.
• Growing attention to the adverse effects of long working hours, particularly on the safety of night operations performed by junior doctors.

Purpose of the Study:

• To urgently examine methods for reducing out-of-hours surgical workload.
• To assess the appropriateness of procedures performed outside standard working hours.
• To inform the work of consultants under the "Achieving a Balance" policy.

Main Methods:

• Two-phase study examining out-of-hours surgical workload in four hospitals.
• Consensus panel review of the appropriateness of surgical procedures and activities.
• Literature review to support the panel's assessment.

Main Results:

• Out-of-hours operations were predominantly performed by junior medical staff.
• Key reasons for night operations included limited daytime theatre availability and the need for surgical experience.
• Significant inter-hospital variation in the frequency of specific operation types performed at night.
• A consensus panel suggested up to 33% of current night operations could be postponed, with a higher potential for postponement after midnight.

Conclusions:

• A substantial portion of night-time surgical procedures may be safely postponed.
• Postponement of non-urgent night operations can reduce junior doctor workload and improve consultant scheduling.
• Findings have significant implications for consultant workload and hospital efficiency following "Achieving a Balance" implementation.