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 standard Infrastructure Facilities Support Services Staffing Enables surgeons to practice to the highest level 2

Yorkshire and the Humber Emergency Surgery Survey 3

Evidence across all specialties, generic and specific standard 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 4

Yorkshire and the Humber Emergency Surgery Survey 5 TotalConsultantTrainee %

Yorkshire and the Humber Emergency Surgery Survey YesNoDon’t know Are you aware of the report? 38.3%61.7% Has your organization/ directorate used this 23.9%11.9%64.2% document? In your organization do critically-ill patients have 83.6%11.4% 05 priority over elective patients? 6

Yorkshire and the Humber Emergency Surgery Survey What services / support are available 7 Total % ITU % HDU % Paediatrics ITU % Paediatrics HDU % Diagnostic Radiology % Vascular Surgery % Interventional Vascular Radiology % Endoscopy % Therapeutic Endoscopy %

Yorkshire and the Humber Emergency Surgery Survey 8 TotalYesNoDon’t know Are there network arrangements for access and transfer % % % % Are there protocols with the ambulance service % 8 4.7% %

Yorkshire and the Humber Emergency Surgery Survey 9 TotalYesNoDon’t know Are all potential admissions seen in A&E % % % 6 3.0% Do A&E staff admit patients without surgical assessment within the A&E setting % % % % Are inappropriate admissions ever made from A&E % % % 8 4.0% Do A&E staff always inform the surgical team a patient has been admitted % % % % Are all surgical admissions sent to a dedicated SAU % % % %

Yorkshire and the Humber Emergency Surgery Survey TotalYesNoDon’t know Can GPs admit directly to a SAU (with or without discussion) % % % % Do trainees ever find “surprise” patients % % % % Has any patient come to harm because of the pathway from A&E % % % % Are acutely-ill patients at high risk of deterioration immediately discussed with the consultant and reviewed by the consultant within 4 hours % % % % As a minimum, are all emergency admissions seen by the admitting surgical consultant within a maximum of 24 hours of admission % % % 6 3.0% 10

Yorkshire and the Humber Emergency Surgery Survey TotalYesNoDon’t know Are critically-ill patients disadvantaged at the expense of elective patients % % % % Do all patients considered as high-risk have all interventions performed under the direct supervision of a consultant % % % % 11

Yorkshire and the Humber Emergency Surgery Survey TotalYesNoDon’t know In specialties with high emergency workload, is the acute team free of elective commitments when covering emergencies % % % 3 1.5% Is a consultant available at all times for telephone advice and can attend within 30 minutes % % 6 3.0% Where possible, are emergency and elective care pathways separated % % % % Are acute care facilities staffed appropriately at all times % % % % Is adequate emergency theatre time provided throughout the day % % % % 12

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