GS10 AN ACUTE CARE SURGICAL SERVICE – A CHANGE IN PARADIGM

Abstract

Background The provision of acute surgical care in the public sector is becoming increasingly more difficult due to the limitation of resources. The lack of predictability of access to theatres during the working day has the effect of displacing elective cases or forcing some acute cases to be performed after hours. An Acute Care Surgical Service was constructed at the Prince of Wales Hospital so as to provide acute surgery in a more timely and efficient manner.Methods A roster of 8 general surgeons was constructed to provide onsite service during the working day and on call service after hours for a 52 week period. An acute care ward of 4 beds and an operating theatre was placed under the control of the Acute Care Surgeon (ACS). At the end of the ACS roster all patients whose treatment was incomplete were handed on to the next rostered ACS. Patient data and theatre utilisation data was prospectively collected and compared to the preceding 52 week period. Data was analysed using unpaired t‐test.Results Emergency theatre utilization during the day increased from 55% to 70%. There was a 15% reduction in acute care operating after hours. Fewer cases were done between midnight and 0800. There was more efficient use of the entire theatre block suggesting a significant cultural change. Staff satisfaction was high.Conclusion On site consultant driven surgical leadership has provided significant positive change to the provision of Acute Surgical Care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.