NCEOD Report Launch

November 11th 2010

John MacFie

Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE

http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

• Workload associated with EGS is far in xs of any other speciality

• This speciality (EGS) has attracted little dedicated resource or committment to research or training

• Standards of care are often unsatisfactory

• Reasons for sub optimal care include:failure to prioritise

inadequate senior input poor clinical leadership unsatisfactory resourcing absence of dedicated managers

Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE

http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

1. Emergency general surgery is a huge clinical service (approx 1000 FCEs 100000 pop)

2. There is evidence to suggest that a committed service reduces litigation, improves workingrelationships and improves outcomes

3. Provision of EGS requires dedicated resources (PAs, theatre)

4. Provision of EGS should be by trained surgeons (? Defined subspeciality)

5. EGS does not require specialist training in major trauma

6. EGS is not R and R surgery

7. it is likely that much EGS will be supervised by CCT holders who are not necessarily consultants

9. EGS does not include any management of acute vascular problems

Figure 1: Trends in demand for NHS care

(Note: the vertical scale is shown logarithmically to aid

comparison between measures of different orders.)

An age old problem

• Initial assessment

• grade clinician making diagnosis

An age old problem : delay

• evidence to suggest that a delay in performing surgery may have contributed to deaths

An age old problem : supervision

• level of supervision was inadequate in almost a third of cases

An age old problem : pre op assessment

• venous thrombosis

• peri-operative antibiotics

• nutrition

An age old problem : nutrition

• nutritional assessment only performed in a minority.......this is likely to have had adverse impact

118/721 height measured 212/730 weight measured 99/723 BMI

An age old problem : MCOP

• level of medical input is unsatisfactory

An age old problem : HDU/ICU

• it is surprising that a greater number of patients did not have enhanced care

Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE

http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

• Workload associated with EGS is far in xs of any other speciality

• This speciality (EGS) has attracted little dedicated resource or committment to research or training

• Standards of care are often unsatisfactory

• Reasons for sub optimal care include:failure to prioritise

inadequate senior input poor clinical leadership unsatisfactory resourcing absence of dedicated managers