Emergency general surgery – A review of acute trusts in the South West

Watkins, Scott; Eyers, Paul

Abstract

As a service, Emergency General Surgery (EGS) represents the largest number of surgical admissions in UK hospitals (1) and accounts for a high number of complications, resulting in long periods of care and a high number of fatalities. It is nationally recognised that there is considerable variability in outcomes between Trusts.

The Clinical Senate held a deliberative session at the end of 2014 considering how EGS services should be configured in the South West, based on available evidence and guidance, so as to provide comprehensive, high quality emergency care that is sustainable for the future. One of the emergent recommendations (2) proposed that a review should be conducted of all current providers of emergency surgery in the South West to assess compliance with existing standards.

The Emergency General Surgery review, was subsequently set up to assess compliance with 22 specific standards (appendix 1) derived from three existing sources (3). Trusts then undertook a self-assessment of compliance with these standards and provided documented evidence to support this. This was followed by a one day visit from a review team who assessed the Trust against the standards
gathering further evidence from a variety of sources.

At the highest level, the review found that over half of the standards were being met by Trusts and over a quarter were partially met. There appeared to be a positive association between the number of standards met and the size of an organisation. However, if the number of partially met standards is included, this relationship disappears with almost all Trusts achieving similar numbers of met standards. The implication being that if we can improve from ‘partially met’ to ‘met’
across the South West, we can deliver a universally high quality EGS service.

Due to variations in infrastructure, description, practice and data availability, this review process was a combination of 'stocktake audit' and an information gathering activity, undertaken to develop an understanding of EGS care in the South West and guide improvements in clinical standards. To aid delivery of this we have developed six main recommendations using the existing standards, coupled with the feedback and commentary of the local clinical teams. We looked for recommendations that would support improved clinical care, safety and outcomes for EGS patients and guide future service provision/development. Furthermore, we felt these recommendations needed to be financially and logistically achievable.

The recommendations can be summarised as:

1. The provision of a protected Surgical Assessment Unit (SAU).
2. The provision of 24/7 CEPOD or Emergency Theatre.
3. A 'South West' standardised, rolling audit of EGS.
4. The appointment of an EGS lead and an Emergency Nurse lead in each Trust.
5. Delivery of 2 consultant led ward rounds per day of EGS patients.
6. Development of a fully integrated ambulatory EGS service.

It is intended that Trusts and commissioners work together to deliver these recommendations, which we believe will produce improved and equitable EGS care across the South West. Implementation of these recommendations will also provide more robust support for future commissioning decisions.

1Association of Surgeons of Great Britain and Ireland. (2007) Emergency General Surgery:
The future. A consensus statement.
http://www.asgbi.org.uk...onsensus_statements.cfm
2 http://www.swsenate.org...es-be-configured-in-the-
south-west/657/
3 (1) RCS (2011) Standards for Unscheduled Surgical Care, (2) London Health Audit (2012)
Quality and Safety Programme (EGS) (3) NHS England (2016) 7 day standards.

• Report Type: Research Report
• Deposit Date: Nov 21, 2023
• Public URL: https://uwe-repository.worktribe.com/output/11457105
• Publisher URL: https://www.swsenate.nhs.uk/wp-content/uploads/2014/01/Emergency-General-Surgery-FINAL-7.2.17.pdf