On this page
Service administration and facilities
Hospitals accepting emergency patients need to be provided with appropriate and adequate facilities. This includes 24 hour availability of the required surgical specialties, anaesthesia, adequate nursing support and ancillary support (such as intensive care, pathology and radiology). Appropriate surgical facilities must be available for day-time surgery and as much of the acute surgery as possible must be performed in protected day-time and emergency surgery lists. These arrangements need to consider local situations and cater for full time staff and visiting surgeons. Hospitals that provide emergency and trauma care need to have an appropriate number of general and orthopaedic surgeons. There also needs to be ready access to surgeons in other specialties (neurosurgery, otolaryngology head and neck, vascular surgery, plastic and reconstructive surgery, paediatric surgery, cardiothoracic surgery, urology, obstetrics and gynaecology and ophthalmology) and many of these surgeons may not be able to be appointed on a 24 hour roster. There may need to be local arrangements whereby surgeons from a number of hospitals share care in order to ensure provision of appropriate services. The College supports the following principles:
- Where possible it is recommended that dedicated emergency theatre space be provided.
- Rostering systems should be established so that surgeons can be available to perform emergency surgery when required.
- Smaller district/regional general hospitals and rural hospitals require facilities that are appropriately resourced for the level of service that is being provided.
- Adequate resourcing of infrastructure, workforce and appropriate administration is essential at all levels.
Surgical appointments and leadership
The College recognises the provision of emergency surgery is a core competency within all surgical specialities. It is essential that surgeons continue to be specifically trained in emergency medicine to enable the broad provision of acute surgical care in all areas. Coordinated systems must be developed and periodically reviewed to improve care for seriously ill and injured patients, and for those who have less serious clinical conditions but who still require surgical review. Leadership of the surgical and clinical teams must be given greater credibility within organisations and surgeons must have input into consultations on improving services in their particular location/area/region. In acute surgical care it is vital that high risk and emergency procedures are led by consultant staff who are best placed to provide the earliest possible treatment assessment.
Senior surgical and nursing staff are often left frustrated by the constant challenge of providing adequate emergency surgical services. As a consequence some staff are opting out of working in emergency care situations or choose to leave public hospital practice altogether. Junior staff, aware of these frustrations, may prefer to take career paths that avoid the need to participate in emergency care, thus compounding the problem. It is therefore essential that ongoing reforms are made in order to make the emergency surgical care environment an attractive place for surgeons to work. In many hospitals there is a requirement for training and teaching of junior staff and the institution must support these roles. Junior staff must be given adequate time to learn new skills and senior clinical staff must be given time to teach as part of their hospital appointment. Further encouragement of post-Fellowship training will both support and lead to career development and leadership opportunities in emergency surgery and trauma. Continuing education and professional development in emergency and trauma care needs to be valued as an important means of maintaining and continually improving standards.
Model of care
For patients who have serious acute surgical or traumatic conditions inefficiencies in the system of retrieval, triage, diagnostic investigation, access to the operating theatre, and appropriate post-operative care may lead to an increased risk of morbidity and mortality. In addressing these issues it is vital that appropriate quality control, adequate data collection and audit processes continue to evolve to support further refinement of services across Australia and New Zealand. Increased financial investment and development of improved leadership, teamwork and management frameworks will lead to the best possible clinical outcomes for patients.