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Can nocturnal emergency surgery be reduced?

D J Sherlock, J Randle, M Playforth

British Medical Journal (Clinical Research Ed.)

|July 21, 1984

Summary

A study found that 35% of emergency surgeries could be deferred. Implementing a daily emergency theatre session could reduce the workload for junior surgical staff during nocturnal hours.

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Area of Science:

Surgical Operations
Hospital Management
Emergency Medicine

Background:

Nocturnal surgery in district general hospitals presents a significant workload for resident junior staff.
Assessing the deferral potential of emergency operations is crucial for optimizing surgical scheduling and resource allocation.

Purpose of the Study:

To prospectively evaluate the feasibility of deferring emergency surgical cases to reduce nocturnal workload.
To identify the proportion of emergency operations that could be safely postponed.

Main Methods:

Prospective study conducted over three months in a district general hospital.
Surgeons completed questionnaires on clinical details, admission time, and deferral possibility for emergency operations.
Independent analysis was performed to corroborate surgeon assessments of deferral safety.

Main Results:

Out of 244 emergency operations, 86 cases (35%) were deemed safely deferrable.
Nocturnal major surgery volume could not be reduced, with 51 out of 71 nocturnal cases being major operations.
A significant portion of nocturnal surgeries (71%) were major operations requiring experienced surgeons.

Conclusions:

A daily emergency theatre session for daytime cases and deferrable nocturnal cases could reduce junior staff workload.
The findings have implications for staffing models, especially if on-call junior medical staff numbers are reduced.
Optimizing surgical scheduling through deferral can improve efficiency and potentially patient outcomes.

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