AB111. SOH24AB_192. Acute on-call general surgery: time for networked care?

Background: Emergency general surgery is usually delivered in addition to routine elective care (supra-elective model) in most centres in Ireland. It is known the number of general surgery consultant teams on call differs across units, with larger model 4 units having less frequent call rotas. In addition, smaller centres provide acute care for non-general surgery conditions such as urology and vascular. We sought to define on-call work-flow for surgical patients in Ireland.

Methods: A reference period was selected, including data from the National Clinical Programme in Surgery, national survey and the National Quality Assurance and Improvement System (NQAIS). Data in the analysis included model of on-call, average admissions per hospital (rotas grouped ≤4, 5–8, >8 members) across all 24 acute general surgery units. Diagnosis-related groups (DRGs) and acuity of admission type were recorded for the majority admissions. Surrogates for efficient care such as average length of stay (aveLOS) were utilised.

Results: There are 24 emergency general surgery teams on call 24/7. The average number of consultants on each rota is 6.2, ranging from 3 to 15. The average number of admissions per unit varies significantly, ranging from 2 to 15 per day. There was a statistically significant difference between admissions by number of consultants on call, with larger units having fewer admissions (11.9 vs. 8.5 vs. 4.6, P<0.021). Acuity was similar across all units.

Conclusions: Smaller units have fewer consultants on the rota, but emergency admissions are a larger component of daily activity. On-call emergency surgery delivery requires redesign in Ireland.

Keywords: Emergency surgery; general surgery; model 3 hospitals; model 4 hospitals; on-call