Dedicated emergency theatres improve service delivery and surgeons' job satisfaction

In the last decade, emergency general surgery (EGS) in Australia and New Zealand has seen a transition from the traditional on‐call system to the acute surgical unit (ASU) model. The importance and growing demand for EGS has resulted in the implementation of the General Surgeons Australia's 12‐point plan for emergency surgery. Since its release, the 12‐point plan has been used as a benchmark of a well‐functioning ASU, both locally and abroad. This study aims to provide a descriptive review on the relevance of the 12‐point plan to the ASU model and review the current evidence to support this framework. The review concludes that the establishment of the ASU model has met the aims set out by the Royal Australasian College of Surgeons for EGS. The 12‐point plan is relevant and has good evidence to support its framework.

Section: Review Of Gsa 12‐point Planmentioning

confidence: 99%

“…Effective communication between various surgical teams and with the duty anaesthetist ensures cases were performed in order of clinical urgency. 60,61 The service must be valued (recognized, rewarded, resourced and renumerated)…”

Section: Egs Should Be Consultant Ledmentioning

confidence: 99%

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

Ang

Wong

Truskett

2019

“…These are each limited to a single hospital or city. Increased satisfaction was observed in 13 Australian EGS surgeons assessed before and after ASU implementation . Similarly, a Canadian study enrolled 12 surgeons working in either the ASU of one hospital or the traditional structure of another, with higher satisfaction observed in the former group .…”

Section: Discussionmentioning

confidence: 96%

“…The ASU model is frequently vaunted to increase EGS staff satisfaction. Although supported by multiple post‐hoc questionnaires of registrars, surgeons or patients, only two comparative studies exist . These are each limited to a single hospital or city.…”

Section: Discussionmentioning

confidence: 99%

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

Kinnear

Tran

Han

et al. 2019

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.

“…At the RAH, patients with acute general surgical problems are admitted by the acute surgical unit (ASU). ASUs have been propagated throughout many tertiary Australian hospitals in the 21st century as a superior way to manage the emergency caseload with improved outcomes for clinicians and patients . The first to be developed was at Prince of Wales Hospital in 2005 .…”

Section: Introductionmentioning

confidence: 99%

Lessons learned from relocating an acute surgical unit to a new quaternary referral centre in Adelaide, South Australia: a tale of two hospitals

Barnett

Finlay

et al. 2019

Background On 4 September 2017, patient care was relocated from one quaternary hospital that was closing, to another proximate greenfield site in Adelaide, Australia, this becoming the new Royal Adelaide Hospital. There are currently no data to inform how best to transition hospitals. We conducted a 12‐week prospective study of admissions under our acute surgical unit to determine the impact on our key performance indicators. We detail our results and describe compensatory measures deployed around the move. Methods Using a standard proforma, data were collected on key performance indicators for acute surgical unit patients referred by the emergency department (ED). This was supplemented by data obtained from operative management software and coding data from medical records to build a database for analysis. Results Five hundred and eight patients were admitted during the study period. Significant delays were seen in times to surgical referral, surgical review and leaving the ED. Closely comparable was time spent in the surgical suite. Uptake of the Ambulatory Care Pathway fell by 67% and the Rapid Access Clinic by 46%. Overall mortality and patient length of stay were not affected. Conclusion We found the interface with ED was most affected. Staff encountered difficulties familiarizing with a new environment and an anecdotally high number of ED presentations. Delays to referral and surgical review resulted in extended patient stay in ED. Once in theatre, care was comparable pre‐ and post‐transition. This was likely from early identification of patients requiring an emergency operation, close consultant surgeon involvement and robust working relationships between surgeons, anaesthetists and nurses.