Modular acute system for general surgery: hand over the operation, not the patient

Abstract

This study describes an efficient and safe system for providing acute general surgical care in a high-volume setting with satisfactory clinical outcomes. It is compatible with the GSA 12-point plan.

General Surgeons Australia's 12‐point plan for emergency general surgery

“…Trauma management has increasingly become a non‐operative and underfunded area of surgery in the USA . In the USA, ACS remains a separate subspecialty with a dedicated fellowship programme …”

“…Koea et al ., in their systematic review, made use of the 12‐point plan to critically analyse the function of seven ASU in Australia as well as European models of care . Local and international units have also appraised their ASU based on the 12‐point plan …”

“…6 In the USA, ACS remains a separate subspecialty with a dedicated fellowship programme. 7 In Australia, the drive towards ASU was due to the increasing demand for EGS in public hospitals which was inadequately managed by the traditional on-call system. A workforce survey carried out by the Royal Australasian College of Surgeons (RACS) in 2005 showed discontentment within the active surgical workforce due to strenuous and sometimes unsafe on-call commitments, compounded by clashes with surgeons' clinic and elective work.…”

Waiting for definitive care: An analysis of elapsed time from decision to surgery or transfer in a rural centre

“…In order to increase availability of daytime operative availability and meet caseload demands, hospitals can create capacity for emergency cases on elective lists, use evening and weekend theatre sessions for semi-urgent cases, and physically separate emergency and elective operating teams. [1][2][3][4][5][6]9,20 However, it is recognised that it is not always possible to delay a procedure until the next morning.…”

“…[1][2][3][4][5][6] Acute surgical care models and emergency general surgery (EGS) units have been developed with the aim of increasing consultant-led patient care, dedicated in-hours emergency theatre lists and improved surgeon satisfaction. 1,3,[6][7][8][9] These have led to reductions in time to definite operative management, as measured by benchmark emergency procedures such as appendicectomy, cholecystectomy and hip joint replacements for femoral fractures. [6][7][8][10][11][12][13] However, many of these studies are based on data from metropolitan hospitals.…”