Emergency general surgery models in Australia: A cross-sectional study
Ned Kinnear, Jennie Han, Minh Tran, Matheesha Herath, Samantha Jolly, Derek Hennessey, Christopher Dobbins, Tarik Sammour, James Moore
Abstract
Background
Emergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. However, the EGS structures in most Australian hospitals remain unknown.
Aims
This study aimed to describe the national spectrum of EGS models.
Methods
Surgical staff were contacted in all Australian public hospitals of medium (> 2,000 patient separations per-annum) or greater peer group. Primary outcomes were incidence of each EGS model. Secondary outcomes were the relationship of EGS model to objective hospital variables, and qualitative reasons for choice of model. An ASU allocated a general surgeon solely to EGS patients for ≥50 per cent of business hours. A Hybrid model did not have this feature, but provided either a doctor-in-training rostered solely to EGS for ≥50 per cent of business hours, or ≥2 protected theatre half-day EGS lists per week.
Results
One hundred and nineteen of 120 eligible hospitals participated (99 per cent). Sixty-four hospitals (54 per cent) reported utilising hybrid model. ASU implementation was significantly more common amongst hospitals of greater peer group (p < 0.0001), bed number (p < 0.0001), surgeon pool (p=0.0003) and trauma service sophistication (p=0.0002). Leading reported drivers for ASU commencement were aims to improve EGS patient care and decrease after-hours operating, while common barriers against ASU uptake were insufficient EGS patient load or surgeon on-call pool.
Conclusion
ASU or Hybrid models of care for EGS patients may be more widespread than currently reported. Introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput.
Full Text:
Emergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. However, the EGS structures in most Australian hospitals remain unknown.
Aims
This study aimed to describe the national spectrum of EGS models.
Methods
Surgical staff were contacted in all Australian public hospitals of medium (> 2,000 patient separations per-annum) or greater peer group. Primary outcomes were incidence of each EGS model. Secondary outcomes were the relationship of EGS model to objective hospital variables, and qualitative reasons for choice of model. An ASU allocated a general surgeon solely to EGS patients for ≥50 per cent of business hours. A Hybrid model did not have this feature, but provided either a doctor-in-training rostered solely to EGS for ≥50 per cent of business hours, or ≥2 protected theatre half-day EGS lists per week.
Results
One hundred and nineteen of 120 eligible hospitals participated (99 per cent). Sixty-four hospitals (54 per cent) reported utilising hybrid model. ASU implementation was significantly more common amongst hospitals of greater peer group (p < 0.0001), bed number (p < 0.0001), surgeon pool (p=0.0003) and trauma service sophistication (p=0.0002). Leading reported drivers for ASU commencement were aims to improve EGS patient care and decrease after-hours operating, while common barriers against ASU uptake were insufficient EGS patient load or surgeon on-call pool.
Conclusion
ASU or Hybrid models of care for EGS patients may be more widespread than currently reported. Introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput.
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