RCSI report proposes new networks for emergency surgery
A report to be published today by the Royal College of Surgeons in Ireland (RCSI) proposes a new networked approach for emergency surgical care which would deliver a higher quality service to patients, preserve access across the country to senior surgical decision-makers, and create a working environment that is optimal for training, recruitment and retention of staff.
The 'Surgery for Ireland' report, which will be launched at the College’s annual Charter Day meeting, sets out a series of recommendations aimed at ensuring equitable regional access to higher-quality emergency surgical services, while ensuring smoother transitions of care for people who require complex emergency surgery.
Most hospitals in Ireland provide emergency surgical care. The current arrangements result in significant variation between hospitals in roster intensity, admission volume and operative complexity with all hospitals having a significant reliance on locum staff. There are challenges in emergency access to specialist surgery and a lack of clarity among surgical trainees about their career trajectory and responsibilities.
The RCSI report proposes that Acute Surgical Assessment Units should be available in every hospital receiving surgical emergencies to streamline surgical assessment and treatment and to allow a reduction in the number of hospitals providing out-of-hours emergency general surgery.
It recommends that geographically-based surgery networks are developed with agreed pathways to allow safe and efficient escalation of care in situations where a patient’s needs exceed the services available locally and to support repatriation when patients needs can be met closer to home.
Optimal staffing of these emergency surgery networks should ensure that every staff member contributes to the extent of their ability and training. The report anticipates that planned rotations of all staff grades between sites within the emergency surgery network, would improve and standardise care as well as enhance recruitment and retention.
The key recommendations include:
- New emergency surgery networks should include injury units, emergency surgery units and emergency surgical centres, with each network supported by access to an elective hospital.
- Emergency surgery centres should have availability of interventional radiology services and endoscopy on a 24/7 basis.
- Each hospital accepting emergency surgery patients should have an Acute Surgical Assessment Unit.
- Emergency and elective surgery should be carried out by the same consultant surgeon workforce in volumes sufficient to maintain the competence of the entire surgical team.
- Emergency duties and scheduled activity should be separate to allow consultant provided care, service continuity and to enable high quality surgical training.
- Consultant surgeons should work across more than one site in the network to enable full participation in both emergency and scheduled care activities.
- With appropriate policies and safeguards, senior surgical decision-maker rosters at emergency surgery units could include not only consultant surgeons but also senior surgical trainees, non-training grade doctors, advanced nurse practitioners and other health and social care professionals.
- Opportunities to increase advanced nurse practitioner and physician associate participation in the emergency surgery workforce should be explored.
Launching the report, RCSI Vice-President Professor Deborah McNamara said: “Access to high quality emergency surgical care is lifesaving and must be available to everyone. Greater life expectancy among Irish people means that emergency surgery patients are more complex and have greater co-morbidity so the demands on our health service to deliver this care will continue to increase. At the same time, advances in surgery, interventional radiology and endoscopy mean that more treatment options than ever before are now available to surgeons and their patients. The majority of emergency operations can be delivered safely in most hospitals but the current system, with onerous on-call rotas and low volumes of high risk cases in many hospitals, makes it difficult for the more complex emergency patients to receive the care they need.
“Emergency surgery is safest when performed during normal working hours by fully-trained staff and where sufficient volumes of surgery are performed to maintain the expertise of the multidisciplinary emergency surgery team. A networked system of emergency surgical care enables most emergency surgical care to be delivered as near as possible to the patient’s home while ensuring equitable access to complex care when required,” added Professor McNamara.