Transcript Slide 1

Yorkshire and the Humber
Emergency Surgery Survey
Jon Ausobsky
RCS Director for Professional Affairs
Yorkshire and the Humber &
Alison Young
Regional Coordinator (North of England)
Yorkshire and the Humber Emergency Surgery Survey
• Supporting surgeons in the workplace
• Evidence as to necessary standards
• Infrastructure
• Facilities
• Support
• Services
• Staffing
• Enables surgeons to practice to the highest level
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Yorkshire and the Humber Emergency Surgery Survey
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Yorkshire and the Humber Emergency Surgery Survey
• Evidence across all specialties, generic and specific
standards for delivery of unscheduled surgical care.
• Survey (2012) Medical Directors of Trusts in Yorkshire and
the Humber.
• Repeat Survey 2014
• Surgeons
• Senior trainees
• Broader question-base
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Yorkshire and the Humber Emergency Surgery Survey
Total
Consultant
Trainee
201
131
70
%
65.2
34.8
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Yorkshire and the Humber Emergency Surgery Survey
Yes
124
61.7%
No
77
38.3%
Don’t know
Has your organization/
directorate used this
document?
48
23.9%
24
11.9%
129
64.2%
In your organization do
critically-ill patients have
priority over elective patients?
168
83.6%
23
11.4%
10
05
Are you aware of the
report?
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Yorkshire and the Humber Emergency Surgery Survey
What services / support are available
Total
201
100.0%
ITU
195
97.0%
HDU
193
96.0%
Paediatrics ITU
65
32.3%
Paediatrics HDU
67
33.3%
Diagnostic Radiology
194
96.5%
Interventional Radiology
135
67.2%
Vascular Surgery
121
60.2%
Interventional Vascular Radiology
112
55.7%
Endoscopy
150
74.6%
Therapeutic Endoscopy
143
71.1%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Yes
No
Don’t
know
Are there network arrangements for
access and transfer
86
50.9%
21
44
12.4% 26.0%
Are there protocols with the
ambulance service
56
33.1%
8
4.7%
93
55.0%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Don’t
know
Yes
No
Are all potential admissions
seen in A&E
40
19.9%
153
76.1%
6
3.0%
Do A&E staff admit patients
without surgical assessment
within the A&E setting
133
66.2%
47
23.4%
17
8.5%
Are inappropriate admissions
ever made from A&E
172
85.6%
15
7.5%
8
4.0%
Do A&E staff always inform
78
the surgical team a patient has 38.8%
been admitted
84
41.8%
26
12.9%
Are all surgical admissions
sent to a dedicated SAU
81
40.3%
19
9.5%
91
45.3%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Yes
No
Don’t
know
Can GPs admit directly to a SAU
(with or without discussion)
97
48.3%
49
24.4%
43
21.4%
Do trainees ever find “surprise” patients
126
62.7%
53
26.4%
19
9.5%
Has any patient come to harm because of the
pathway from A&E
55
27.4%
52
25.9%
90
44.8%
Are acutely-ill patients at high risk of deterioration
immediately discussed with the consultant and
reviewed by the consultant within 4 hours
122
60.7%
47
23.4%
30
14.9%
As a minimum, are all emergency admissions seen
by the admitting surgical consultant within a
maximum of 24 hours of admission
180
89.6%
14
7.0%
6
3.0%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Yes
No
Don’t
know
Are critically-ill patients disadvantaged at the
expense of elective patients
19
9.5%
167
83.1%
15
7.5%
Do all patients considered as high-risk have all
interventions performed under the direct
supervision of a consultant
142
70.6%
39
19.4%
18
9.0%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Yes
No
Don’t
know
In specialties with high emergency workload, is
the acute team free of elective commitments
when covering emergencies
140
69.7%
45
22.4%
3
1.5%
Is a consultant available at all times for telephone
advice and can attend within 30 minutes
192
95.5%
6
3.0%
3
1.5%
Where possible, are emergency and elective care 134
pathways separated
66.7%
48
23.9%
14
7.0%
Are acute care facilities staffed appropriately at
all times
103
51.2%
81
40.3%
14
7.0%
Is adequate emergency theatre time provided
throughout the day
87
43.3%
102
50.7%
10
5.0%
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Yorkshire and the Humber Emergency Surgery Survey
n = 201
Don’t
know
Yes
No
Do you feel there is a commitment from the executive team
to provide high quality emergency and surgical services
97
48.3%
60
29.9%
42
20.9%
Where units operate in a network, are there good links with
other surgical units in the network and with supporting
services within and outside the organization
110
54.7%
22
10.9%
42
20.9%
In specialties with a high emergency workload, do
consultants cover more than one site when on-call
88
43.8%
92
45.8%
6
3.0%
Do trainees cover more than one site when on-call
45
22.4%
151
75.1%
2
1.0%
Is trainees’ working time arranged to maximise exposure to 143
emergency care (assessment & diagnosis, decision making, 71.1%
operative and non-operative management) when on-call
38
18.9%
18
9.0%
Is the on-call rota safe i.e. there are sufficient trainees to
cover A&E/SAU/elective patients/theatres
65
32.3%
14
7.0%
119
59.2%
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Free text responses (66)
• 13 – Good provision
• Dedicated surgical consultant week o/c; consultant led
ward round 2 x day; dedicated emergency theatre 6 days
week
• theatre capacity constantly reviewed for emergencies
• changes to care pathway already made or planned soon
• 12 – Adequate or adequate to poor provision
•
•
•
•
poor at weekends
no anaesthetic cover between 6pm – 8pm
over running of elective lists
continuity of care is sub-optimal
Free text responses (continued)
• 10 – Under provision of emergency theatres
• no dedicated CEPOD list despite busy department
• no theatre space available and no time allocated
• 6 – Units and rotas are understaffed
• Interventional radiology not readily available at weekends
• not enough surgical cover at night
• 9 – Management “will” (or “won’t!)
• resistance to improve acute care and emergency surgery
is a low priority – cost implications and too much
concentration on elective targets
• have policies but it doesn’t always happen
Free text responses (continued)
• 5 – Other
•
•
•
•
•
access to tertiary services an issue
low provision of general children’s emergency surgery
24hr emergency admission but no OOH operating
demand from A&E (esp. frail / elderly) is rising
need to merge Trusts to have hot & cold sites
• 11 – Difficult to answer / give further comments
Thank you
Any questions?