'Unseen' on-call workload of a general surgical team

Over a four-month period, we assessed the contribution made to the on-call workload of a general surgical team, by referrals and assessments of patients who had not been admitted under surgical care and were therefore not recorded in current audits of general surgical activity--the 'unseen workload'. Up to 5 1/2 hours per day on-call (mean 101 minutes) was spent assessing these referrals. There was a mean number of 3.6 referrals (range 1 to 7). Although 51 percent of these referrals were deemed to be non-surgical after assessment, the majority (77 percent) were believed to be appropriate. The Accident & Emergency Department referred 46 per cent of patients with only 7 percent requiring surgical management. This study shows that while hours of work are important in assessing the workload of a junior doctor on-call, the intensity of the workload is just as important in determining the impact on staff. There is a greater workload than revealed by audit of just surgical admissions and operations alone.