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Analysis of a year's general surgical activity in a District General Hospital
1Department of Surgery, Taunton & Somerset NHS Trust.
Insights
Surgical unit activity in a District General Hospital exceeded expectations, with high emergency admission bed days. Unsupervised trainees performed most emergency operations, while clinical assistants contributed significantly to operative workload.
Area of Science:
- Healthcare Management
- Surgical Services Analysis
- Hospital Operations
Background:
- District General Hospitals are crucial for providing surgical care.
- Understanding surgical unit activity is essential for resource allocation and quality improvement.
- Previous analyses have not fully detailed the workload distribution within such units.
Purpose of the Study:
- To analyze the surgical unit's activity over one year.
- To compare observed activity against expected workload based on personnel.
- To evaluate the contribution of different surgical staff grades to operative procedures.
Main Methods:
- Retrospective analysis of surgical unit data over a 12-month period.
- Data collection included outpatient numbers, admissions, operations performed, and bed day occupancy.
- Workload was assessed using Service Equivalent Value (SEV) for consultants, trainees, and clinical assistants.
Main Results:
- Surgical unit activity (outpatients, admissions, operations) exceeded expected levels for its size.
- Emergency admissions constituted 35% of cases but occupied 58% of bed days.
- Unsupervised trainees performed 42.5% of operations, including the majority of emergency procedures (73.7%).
- Consultants performed/supervised 48% of operations; clinical assistants contributed more SEV than expected.
Conclusions:
- The surgical unit operates at a higher-than-expected capacity.
- Emergency care significantly impacts bed day utilization.
- Trainee surgeons, particularly unsupervised ones, play a substantial role in emergency operative procedures.
- Clinical assistants provide a valuable contribution to the surgical workload.
Abstract:
The activity of the surgical unit of a District General Hospital was analysed over a one-year period. The numbers of outpatients seen, admissions, operations performed, and operative workload were all higher, in terms of the available surgical personnel, than those expected of a unit of this size. Thirty-five per cent of admissions were emergencies but these occupied 58 per cent of bed days. Nonetheless, three-quarters of admitted patients were discharged within five days. Three-quarters of operations were Minor or Intermediate, one-quarter were Major or more complex. Consultants performed/supervised 48 per cent of operations. 42.5 per cent were performed by unsupervised trainees and 9.4 per cent by clinical assistants. Solo trainees performed the majority of emergency operations (73.7 per cent). With regard to operative activity, the Service Equivalent Value of consultants and trainees approximated to expectations, but clinical assistants contributed more than expected.