The efficiency of management of emergency surgery in a district general hospital--a prospective study

In a 6-month prospective study of management of surgical emergencies in a district general hospital, we have tried firstly to determine the degree to which non-life-threatening emergencies could be managed within 'social hours' (0800-1800), and secondly to identify examples of and reasons for potentially hazardous delay in the performance of urgent procedures. Emergency referrals undergoing surgery were categorised into three groups: Group A--patients requiring surgery either immediately or at the earliest possible time (maximum 3 h after diagnosis). Group B--patients requiring urgent but not immediate surgery (within 6 h of diagnosis). Group C--patients whose operations could be delayed until social hours without detriment. The reason for delay--shortage of theatre nursing, anaesthetic or surgical staff--was recorded in each case. Of the 95 patients in Group C (elective management) 63 (65%) underwent surgery within social hours, 15 (16%) between 1800 and 2100 and 17 (18%) at night. Unacceptable delays occurred in 37 (14%) of the 260 cases and were most likely to affect patients in Group A who most needed urgent care. We conclude that our current staffing levels in theatre nursing should be increased to consistently provide two (rather than one) staffed theatres for emergencies, in addition to a theatre team dedicated exclusively to obstetrics. Anaesthetic manpower should be increased to provide four duty anaesthetists with no more than one at SHO level as obstetric and intensive care duties can be complex. General surgical staffing requires expansion in order that on-call staff have no fixed commitments during and in the session immediately after their duty periods.