Audit of emergency throughput in a regional plastic surgery unit

A prospective study of emergency admissions to a regional plastic surgery unit was performed to investigate the extent and causes of delay between injury and operation. Details of 52 consecutive admissions, excluding those to the burns unit, were collected over a 50-day period. The mean delay between the injury and start of operation was 16.9 h (range 4.33-52.75 h). For patients referred from other hospitals in the region (n = 35) the mean delay between referral and admission was 3.64 h (range 0.5-17 h). This delay was 1.06 h (range 0-4.0 h) for those referred from the on-site accident and emergency department (n = 17). These results show that there is an excessive delay in treating these patients, but that transfer times to a regional centre contribute relatively little to the overall delay. The cause of this delay in the majority of cases was identified as lack of theatre availability. As a consequence of this 38% of operations took place after 2300 hours. If late-night operating was reduced, delay would worsen unless a second emergency theatre was made available between 1700 and 2300 hours, or emergency cases replaced elective ones on routine operating lists.