Emergency general surgeons, subspeciality surgeons and the future management of emergency surgery: results of a national survey

Abstract

Aim This study aimed to survey consultants’ experience of working as or with emergency general surgery (EGS) surgeons and to investigate the role they fulfil in the management of general and subspeciality emergencies. Method An electronic survey, designed to capture both quantitative and qualitative data, was piloted and then circulated to members of the Association of Coloproctology of Great Britain and Ireland. Results Two hundred and forty‐two responses were received from 848 recipients (a 29% response rate) covering 104 of 135 (77%) acute NHS Trusts in England. EGS surgeons were in post in 43/141 (30%) hospitals overall and 12/24 (50%) of hospitals in London. Most respondents working in units with EGS surgeons found them to be advantageous (46/63, 73%). Consultants working with EGS surgeons were significantly more likely to support their use (49/63, 78%) than those without them (83/178, 47%) (χ2 = 16.9, P < 0.001). EGS surgeons were considered to improve the delivery of EGS (78%), create time for subspecialists (70%) and provide service (73%). However, there were concerns about the quality of surgery (43%), an insufficient standard of specialist care (54%) and compromise in the training of juniors (25%). Respondents commented on a lack of job structure with a high attrition rate (21%), the insufficient quality of applicants (18%) and that subspecialization and split on‐call was preferable (17%). Conclusion Respondents were supportive of the ability of EGS surgeons to relieve pressure on subspecialists; however, there were significant concerns about the sustainability and quality of the EGS surgeon role. Emergency colorectal resections should have the input of a surgeon who performs elective colorectal resections.

Emergency general surgery models in Australia: A cross-sectional study

“…2 Similarly, a UK online questionnaire enrolled ≥1 colorectal surgeon from 104/135 (77 per cent) acute nonspecialist National Health Service Trusts, and reported ASU uptake in 26 per cent of hospitals. 19 Taken together, ASU implementation rates in developed nations range from 8-29 per cent, similar to our findings. In comparison to other works, this study enjoyed an excellent response rate of 99 per cent.…”

Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database

“…It is clear, however, that demand for emergency surgery services is increasing and this is associated with an increase in advertisements for specific EGS consultant jobs. 5,11,27 Indeed, many subspecialists are in favor of broadening the base of emergency surgeons with 78% respondents from a recent survey of UK surgeons reporting a perceived improvement in the delivery of emergency care with an EGS service. 5 However, no study to date has looked at the impact of an emergency surgery service on laparotomy outcomes.…”

“…3 Health care systems continue to experience growing demand for emergency services, driven by an aging population and limited resources. One way in which this is being increasingly addressed is the care of emergency admissions by a dedicated subspecialty or clinical team for emergency surgical admissions, most commonly termed "emergency general surgery" in the United Kingdom, or "acute care surgery" (ACS) in North America, [4][5][6] in contrast to the traditional general surgeon on-call (GSOC) model of care in which acute admissions are managed by a general surgical specialist wherein a rotating block of "on call" shifts supplants normal elective activity.…”

“…10 In the United Kingdom, increasing subspecialization with the intention of improving outcomes for patients undergoing elective operations, has, together with an increase in demand for service left gaps in the provision of consultant, led emergency surgery care 3,11 ; the need for dedicated emergency general surgeons is increasing to meet this service requirement. 5,11 The EGS model of care has been gradually introduced in the United Kingdom over the last two decades to address the increased demand for emergency surgery. Its implementation has been variable and ranges from a single emergency general surgeon participating in an on-call rota to an entire emergency surgery team with 7 days per week care delivery by a dedicated team.…”

A sub-specialised emergency general surgery on call can improve theatre utilisation

“…Additionally, in National Health Service (NHS) trusts across England, emergency admissions have increased by 25%, whereas the workforce has only increased by 8%. 1,2 This has led to an increased interest in restructuring of the emergency surgery provision with introduction of dedicated emergency general surgeons and also the introduction of subspecialty on calls such as lower GI/upper GI.…”