NCEOD Report Launch November 11 th 2010 John MacFie

Association of Surgeons of Great Britain and Ireland EMERGENCY GENERAL SURGERY: PRESENT AND FUTURE 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 Ireland EMERGENCY GENERAL SURGERY: PRESENT AND FUTURE 1.Emergency general surgery is a huge clinical service (approx 1000 FCEs pop) 2.There is evidence to suggest that a committed service reduces litigation, improves working relationships 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 Ireland EMERGENCY GENERAL SURGERY: PRESENT AND FUTURE 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