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General surgery with a special interest in vascular surgery: an audit of relative workload
V Jaffe1, L Chadwick, M Tomkins
1Department of Surgery, Royal Berkshire Hospital.
Insights
Vascular surgery in district general hospitals (DGHs) involves significant general surgical cases. However, vascular procedures consume disproportionately more resources, including beds and theatre time, impacting service planning.
Area of Science:
- Vascular Surgery
- General Surgery
- Healthcare Management
Background:
- District general hospitals (DGHs) often integrate vascular surgery within general surgery departments.
- A debate exists regarding the specialization of vascular surgeons versus generalists with vascular interests.
Purpose of the Study:
- To analyze the workload and resource utilization of vascular and general surgery in a DGH.
- To define the relationship between general and vascular surgical activities within a DGH setting.
Main Methods:
- Prospective analysis of outpatient, inpatient, and theatre workload over three months.
- Inclusion of 844 patients (277 new, 567 follow-up) across general and vascular surgery.
Main Results:
- Vascular patients occupied 46% of bed occupancy despite representing 26% of the caseload.
- Vascular operations consumed 34% of theatre time, disproportionate to their 21% caseload share.
- Vascular patients had significantly longer hospital stays compared to general surgery patients.
Conclusions:
- DGH vascular units manage a considerable volume and variety of general surgical cases.
- Vascular surgery demands disproportionately high outpatient, theatre, and bed resources.
- Findings have significant implications for vascular service planning and hospital resource allocation.
Abstract:
In a district general hospital (DGH) almost all vascular surgery is provided by general surgeons with a vascular interest and training. There is a growing view, however, that vascular surgeons should be 'pure' to the exclusion of other surgery. In an attempt to define the relationship between general and vascular work in a DGH we have analysed, prospectively, out-patient, in-patient and theatre workload over a three-month period. Eight-hundred-and-forty-four patients (277 new, 567 follow-up) were seen in the clinics. Nine per cent of new vascular referrals and 33 per cent of new general referrals were booked for admission. There were 356 admissions (50 per cent 'emergencies') representing a wide spectrum of general surgery. Elective and emergency vascular cases stayed in hospital for twice and four times longer, respectively, than general patients. Vascular patients represented 26 per cent of the caseload but accounted for 46 per cent of the bed occupancy. Vascular operations made up only 21 per cent of the total theatre caseload (233 procedures) but consumed 34 per cent of theatre time. The vascular unit in a DGH deals with a substantial number and wide variety of general surgical cases. Vascular surgery, however, consumes disproportionately large amounts of out-patient and theatre time and hospital beds. This has implications both for the planning of vascular services and also for the resource allocation within the hospital.