Defining minimum work priorities in emergency general surgery in a national cohort

Area of Science:

• Surgical Care Delivery Models
• Health Systems Research

Background:

• Emergency general surgery delivery often conflicts with routine elective surgical care.
• Models like acute surgical assessment units and reduced elective working are explored to manage competing demands.
• Understanding current models, patient cohorts, and staffing is crucial for optimizing surgical services.

Purpose of the Study:

• To identify and analyze models for delivering emergency general surgery.
• To characterize patient cohorts managed under different surgical delivery systems.
• To assess staffing levels within various emergency general surgery models.

Main Methods:

• Data sourced from the National Quality Assurance and Improvement System (NQAIS) and published literature.
• International models of acute surgical service delivery were compiled from national surgical bodies and position statements.
• Analysis focused on identifying operational models, patient demographics, and staffing structures.

Main Results:

• Traditional on-call models dominate, with limited separation of acute and elective surgical streams.
• International trends show a move towards separating acute and elective care for improved efficiency.
• Model 3 hospitals face challenges with broad skill requirements due to a lack of local specialists, unlike Model 4 hospitals.

Conclusions:

• Widespread adoption of separate on-call and elective workstreams is limited in national hospitals.
• Separating acute and elective surgical priorities is essential but challenging with current staffing.
• Implementing Acute Surgical Assessment Units (ASAUs) within networks may enhance outcomes through care regionalization.