Does emergency general surgery model affect staff satisfaction, training and working hours?

Abstract

Background Few studies have assessed the relationship between different emergency general surgery models and staff satisfaction, operative experience or working hours. The Royal Australasian College of Surgeons recommends maximum on‐call frequency of one‐in‐four for surgeons and registrars. Methods A cross‐sectional study was conducted of all medium‐ to major‐sized Australian public hospitals offering elective general surgery. At each site, an on‐call general surgery registrar and senior surgeon were invited to participate. Primary outcomes were staff satisfaction and registrar‐perceived operative exposure. Secondary outcomes were working hours. Results Among eligible hospitals, 119/120 (99%) were enrolled. Compared with traditional emergency general surgery models, hybrid or acute surgical unit models were associated with greater surgeon and registrar satisfaction on quantitative (P = 0.012) and qualitative measures. Registrar‐perceived operating exposure was unaffected by emergency general surgery model. Longest duration on‐duty was higher among traditional structures for both registrars (mean 22 versus 15 h; P = 0.0003) and surgeons (mean 59 versus 41 h; P = 0.020). On‐call frequency greater than one‐in‐four was more common in traditional structures for registrars (51% versus 28%; P = 0.012) but not surgeons (6% versus 0%; P = 0.089). Data on average hours per day off‐duty were obtained for registrars only, and were lower in traditional structures (13 versus 15 h; P = 0.00002). Conclusion Hybrid or acute surgical unit models may improve staff satisfaction without sacrificing perceived operative exposure. While average maximum duration on‐duty exceeded hazardous thresholds for surgeons regardless of model, unsafe working hours for registrars were more common in traditional structures. General surgical departments should review on‐call rostering to optimize staff and patient safety.

Status quo of operative training in emergency surgery in Germany – results of a survey

“…The framework conditions of the training cannot be easily transferred from elective surgery to emergency procedures. Emergency procedures often do not take place in the elective daily program, but are carried out at times of fewer resources [ 2 ], which narrows the corridor of trainees to the assistant on duty or specialist. Even with personal willingness, the Working Time Act also represents a restriction here.…”

“…In the context of urgent or emergency surgical procedures, training assistants and trainers alike face various hurdles that need to be checked before the teaching assistance can possibly be implemented. This includes (1) the content knowledge of the training assistant about the case, (2) the practical skills to manage the emergency, and (3) the circumstances of the procedure in terms of complexity, resources, and patient endangerment.…”

Patient Satisfaction in Emergency General Surgery: A Prospective Cross‐Sectional Study

“…A small number of ASU studies have reported subjective outcomes, including the satisfaction of surgeons [10], trainees [11], emergency physicians [12] or even doctors’ approximations of patient satisfaction, estimated without patient input [12, 13]. None of these ASU studies have measured patient‐reported outcomes.…”

The acute care surgery model and elective surgery

“…[8][9][10] In the past 15 years or so, numerous benefits of the ACS model of care have been noted from improved outcomes, [11][12][13][14][15][16] increased efficiency, 11,15,17 and better job satisfaction. [18][19][20] One of the most important benefits of the ACS model is increased interest in the field. 21 If we accept Maier's premise that "applicant statistics for RRC-approved surgical critical care fellowships" can serve as surrogate marker for interest in acute care surgery, then we are on the right track.…”

“…In the past 15 years or so, numerous benefits of the ACS model of care have been noted from improved outcomes, 11–16 increased efficiency, 11,15,17 and better job satisfaction 18–20 . One of the most important benefits of the ACS model is increased interest in the field 21 .…”