Objectives-To determine (a) whether doctors involved in the process of emergency surgical admission could agree about which patients should be admitted, (b) whether there were consistent differences between doctors in different speciality groups, and (c) whether these opinions were greatly influenced by nonclinical factors. Design-Independent assessment of summarised case histories by three "expert" clinicians (two consultant surgeons and one general practitioner (GP)), by a group of 10 GPs, and by a group of 10 in the organisation and funding ofacute surgical services, changes in public attitudes, and changes in medical attitudes.The last of these is clearly pivotal, since doctors have the responsibility of defining whether acute hospital admissions are necessary or not. We do not know whether there is general agreement within the profession about what constitutes a "necessary" admission, but such a consensus is clearly necessary to allow rational analysis of the problems posed by increasing numbers of such admissions. Surgical emergency admissions have received less attention than medical emergencies, but the rise in numbers appears to affect all specialty groups. We therefore set out to determine the attitudes of the doctors directly involved in admitting surgical patients to hospital. The training and clinical role of different types of doctors may lead to differences of opinion about the appropriate management of patients presenting with acute "surgical" conditions. We therefore asked whether doctors involved in the process of emergency surgical admission could agree about which patients should be admitted, whether there were consistent differences between doctors in different speciality groups, and whether these opinions were greatly influenced by non-clinical factors. To answer these questions we asked doctors involved in the emergency admission process to evaluate case summaries of a series of real emergency admissions to the Fazakerley surgical unit.

No abstract

No abstract