Accident and emergency content of general surgical workload

In a 12-month period from 1 January to 31 December 1982, 1064 patients were admitted under the care of one consultant general surgeon. Of these, 485 came through the Accident and Emergency (A & E) Department; details of their management are presented. All the data were collected prospectively, stored on microcomputer discs and later analysed. The surgical cases provided adequate material for training but the planning of curricula did not allow all the A & E trainees to be adequately exposed to it. Head injuries accounted for nearly one-third of the emergency workload and were well managed, but more children with this diagnosis were admitted than was necessary. About one-quarter of the investigations performed did not contribute usefully to management; adequate discussion between the laboratories and clinicians and the laying-down of written guidelines may reduce the number of unnecessary investigations. A system which enables casualty officers to follow up the patients whom they admit will help trainees to confirm or refute their initial diagnostic impressions, and should be encouraged. A knowledge of the number, type and outcome of treatment of general surgical cases passing through the A & E Department is important in planning curricula and also for allocating resources.