PWE-416 Does a general surgery dual-specialty consultant on-call system improve emergency access to appropriate specialist surgery?. (22nd June 2015) - Kirby, GC
Abstract : Introduction: Subspecialisation within general surgery has resulted in concerns over the provision of emergency surgical care. Outcomes after some elective surgery have been shown to be better when performed by a surgeons of an appropriate subspeciality. 1 Some advocate emergency surgery should be considered in the same way, and performed by appropriately trained specialists. A dual consultant on-call system has been proposed as a means of ensuring this occur. This study aims to identify whether patients receive subspecialty emergency surgical intervention using an in-hours dual consultant on-call system. Method: A prospective review of all emergency laparotomies performed at a single centre from 11/01/2014 to 12/01/2015. Data was collected on indication for surgery, operative findings, subspecialty interest of operating surgeon, and the timeliness of surgery compared to CEPOD operative urgency grading. Operations were classified as General: suitable for any surgeon (GEN); Upper Gastrointestinal (UGI); and Colorectal (COL). Our centre operated a dual consultant on call system within normal working hours, and single consultant outside hours. Results: 306 emergency laparotomies were identified. 169 (55%) were classified as GEN; 22 (7%), UGI; 115 (38%), COL by procedure. The most senior surgeon present was consultant in 281 (92%) of cases, Specialist Trainee in 24 (8%), and unknown in 1. (36) 12% of cases were due to a complication of previous surgery. 20% of cases were performed out-of-hours. Within normal working hours, 90 of 103 (87.4%) operations of a specialist nature were performed by a consultant surgeon of that specialty. Outside of these hours, this figure was 15 out of 27 (55.6%). 95% of cases were performed within the NCEPOD operative timing classification. Conclusion: A dual consultant on-call system does result in the majority of patients receiving emergency care by a surgeon with the appropriate subspeciality interest, and allows this to occur in a timely fashion. Disclosure of interest: None Declared. Reference: Anwar S, Fraser S, Hill J. Surgical specialization and training – its relation to clinical outcome for colorectal cancer surgery. J Eval Clin Pract . 2012 Feb;18(1):5–11