Emergency general surgery: challenges and opportunities

The Nuffield Trust was commissioned by the Royal College of Surgeons of England to explore the challenges facing emergency general surgery and identify opportunities to overcome them.

The most significant challenges faced by emergency general surgery include variation in outcomes, workforce, organisational and operational issues and underlying demographic and epidemiological trends. At the heart of these challenges are two inter-related issues. Firstly, the desire to reduce variation in outcomes for EGS (particularly high risk surgery) and second, the need to resolve the tension between increasing pressures to centralise EGS services while political and demographic pressures argue for sustaining local access.

We conducted a number of interviews with experts, performed a rapid assessment of the literature and undertook a detailed piece of novel quantitative analysis. This work fed into a seminar, held in September 2015 and attended by senior stakeholders across surgery, medicine, anaesthetics, radiology, pre-hospital medicine, advanced nursing and management.

Our report suggests potential solutions to the problems facing EGS. The quickest gains could be achieved through the systematic use of protocols and pathways. The most comprehensive means to address the challenges faced by EGS would be the development of managed clinical networks. We also recommend that all hospitals consider the potential for new roles in EGS. Finally, we have laid out options for future training models, which would be the longest-term solution to the challenges facing EGS.

This report brings together the findings of our preliminary research, seminar, and subsequent exploration and analysis. It offers the reader practical opportunities to improve the provision of EGS and provides health care leaders with important points to consider when reviewing changes to EGS services.

Partners

Royal College of Surgeons

Suggested citation

Watson R, Crump H, Imison C, Currie C and Gaskins M (2016) Emergency general surgery: challenges and opportunities. Research Report. Nuffield Trust.