EGS P20 Emergency General Surgery – A state of the nation survey
Authors: Olivier James 
Published: December 2022

Background

ERAS (enhanced recovery after surgery) programmes have delivered improved outcomes across the elective surgery landscape but emergency surgery has historically lagged behind with its improvements. The introduction of acute care surgery principles in the United States and projects such as NELA (National Emergency Laparotomy Audit) in the United Kingdom are working to change this.

Despite the improvement in outcomes seen by NELA there lacks clarity over the structure and provision of services across the UK. No study to date has examined how Emergency General Surgery care is currently organised and therefore how these organisational structures are changing as new innovations to patient care are delivered. This study aims to ascertain the current organisation structures of emergency surgical care within England and whether there are plans for this to change.

Methods

A survey was defined and sent to hospitals across England via Freedom of Information (FOI) Requests. Trusts were identified from the online NHS Service Directory and cross referenced with the NELA list of participating hospitals. This led to FOIs sent to 123 acute Trusts in England. Responses not received within 8 weeks were not included in the study.

Questions were identified and wording agreed by the authors. Trusts were asked their current working structure and whether they have plans to change within the next five years. Organisational structures were categorised as A; Mixed general surgical take under a non-specific general surgery consultant, B; Daily allocation of acute admission to a general surgery subspecialty (Upper GI / Colorectal / Hepatobiliary), C; Dedicated Emergency General Surgery consultants / service during weekdays only (Monday to Thursday, or Monday to Friday), D; Dedicated Emergency General Surgery consultants / service weekdays and weekends, or E; Other.

Results

101 out of 124 trusts responded within the 8-week timeframe. 3 trusts declined to supply information on organisational structure. The remaining reported organisational structures of A; n=36, B; n= 16, C; n=10, D; n=30, E; n=5. In total 41.24% of hospitals reported having an active EGS service in place.

Mean bed numbers across different organisational types were Group A; 617.62, Group B; 867, Group C; 648, Group D; 559.5, Group E; 800.71. Mean admissions were Group A; 3983.08, Group B; 6088.29, Group C; 4432.14, Group D; 4123.52, Group E; 4578. Mean NELA cases were Group A; 134.29, Group B; 187, Group C; 164, Group D; 142.11, Group E; 187.17.

Regarding number of consultants in place to run an EGS service group C reported a range of 2 to 14 consultants, with a mean of 6. Group D reported a range of 3 to 13 consultants, with a mean of 8.14.

Regarding plans to move towards an EGS service group A reported Yes; 9 (25%), No; 22 (61.11%), TBD; 2 (5.56%), no answer given; 3 (8.33%). Group B reported Yes; 3 (18.75%), No; 10 (62.5%), TBD; 3 (18.75%).

Conclusions

The speciality of Emergency General Surgery (EGS) within the United Kingdom is expanding with annual EGS symposiums being held by professional bodies such as ASGBI, EGS trainee groups forming such as the Moynihan Academy, and large institutions altering their service specifically towards hiring consultants in EGS positions. This follows the Royal College's Acute and Emergency Care joint position statement, the consensus statement from ASGBI and the Getting It Right First Time (GIRFT) emergency surgery report which explicitly state that a dedicated surgical assessment unit, with senior surgeon directing patient throughput has been shown to reduce costs and increase effectiveness of a surgical department.

This study shows that 41.24% of trusts in England deliver an EGS service but in heterogenous structured formats. What is clear is that a dedicated EGS service is becoming more popular, with 25% of group A services, and 18.75% of group B services reporting active plans in the next 5 years to create this service. This further impresses the need for categorisation of service provision types, and the sharing of information, to ensure that England does not end with a patchwork of service types confusing patients and rotating clinical practitioners alike.