1. 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)

2. Yorkshire and the Humber Emergency Surgery Survey Supporting surgeons in the workplace Evidence as to necessary standards Infrastructure Facilities Support Services Staffing Enables surgeons to practice to the highest level 2

3. Yorkshire and the Humber Emergency Surgery Survey 3

4. Evidence across all specialties, generic and specific standards 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

5. Yorkshire and the Humber Emergency Surgery Survey 5 TotalConsultantTrainee 20113170 %65.234.8

6. Yorkshire and the Humber Emergency Surgery Survey YesNo Don’t know Are you aware of the 12477 report? 61.7%38.3% Has your organization/4824129 directorate used this 23.9%11.9%64.2% document? In your organization do 1682310 critically-ill patients have 83.6%11.4%05 priority over elective patients? 6

7. Yorkshire and the Humber Emergency Surgery Survey What services / support are available 7 Total201100.0% ITU19597.0% HDU19396.0% Paediatrics ITU 6532.3% Paediatrics HDU 6733.3% Diagnostic Radiology19496.5% Interventional Radiology13567.2% Vascular Surgery12160.2% Interventional Vascular Radiology11255.7% Endoscopy15074.6% Therapeutic Endoscopy14371.1%

8. Yorkshire and the Humber Emergency Surgery Survey 8 n = 201YesNoDon’t know Are there network arrangements for access and transfer 86 50.9% 21 12.4% 44 26.0% Are there protocols with the ambulance service 56 33.1% 8 4.7% 93 55.0%

9. Yorkshire and the Humber Emergency Surgery Survey 9 n = 201YesNoDon’t know Are all potential admissions seen in A&E 40 19.9% 153 76.1% 6 3.0% Do A&E staff admit patients without surgical assessment within the A&E setting 133 66.2% 47 23.4% 17 8.5% Are inappropriate admissions ever made from A&E 172 85.6% 15 7.5% 8 4.0% Do A&E staff always inform the surgical team a patient has been admitted 78 38.8% 84 41.8% 26 12.9% Are all surgical admissions sent to a dedicated SAU 91 45.3% 81 40.3% 19 9.5%

10. Yorkshire and the Humber Emergency Surgery Survey n = 201YesNoDon’t know Can GPs admit directly to a SAU (with or without discussion) 97 48.3% 49 24.4% 43 21.4% Do trainees ever find “surprise” patients126 62.7% 53 26.4% 19 9.5% Has any patient come to harm because of the pathway from A&E 55 27.4% 52 25.9% 90 44.8% Are acutely-ill patients at high risk of deterioration immediately discussed with the consultant and reviewed by the consultant within 4 hours 122 60.7% 47 23.4% 30 14.9% As a minimum, are all emergency admissions seen by the admitting surgical consultant within a maximum of 24 hours of admission 180 89.6% 14 7.0% 6 3.0% 10

11. Yorkshire and the Humber Emergency Surgery Survey n = 201 YesNoDon’t know Are critically-ill patients disadvantaged at the expense of elective patients 19 9.5% 167 83.1% 15 7.5% Do all patients considered as high-risk have all interventions performed under the direct supervision of a consultant 142 70.6% 39 19.4% 18 9.0% 11

12. Yorkshire and the Humber Emergency Surgery Survey n = 201YesNoDon’t know In specialties with high emergency workload, is the acute team free of elective commitments when covering emergencies 140 69.7% 45 22.4% 3 1.5% Is a consultant available at all times for telephone advice and can attend within 30 minutes 192 95.5% 6 3.0% 3 1.5% Where possible, are emergency and elective care pathways separated 134 66.7% 48 23.9% 14 7.0% Are acute care facilities staffed appropriately at all times 103 51.2% 81 40.3% 14 7.0% Is adequate emergency theatre time provided throughout the day 87 43.3% 102 50.7% 10 5.0% 12

13. Yorkshire and the Humber Emergency Surgery Survey n = 201YesNoDon’t know Do you feel there is a commitment from the executive team to provide high quality emergency and surgical services 97 48.3% 60 29.9% 42 20.9% Where units operate in a network, are there good links with other surgical units in the network and with supporting services within and outside the organization 110 54.7% 22 10.9% 42 20.9% In specialties with a high emergency workload, do consultants cover more than one site when on-call 88 43.8% 92 45.8% 6 3.0% Do trainees cover more than one site when on-call45 22.4% 151 75.1% 2 1.0% Is trainees’ working time arranged to maximise exposure to emergency care (assessment & diagnosis, decision making, operative and non-operative management) when on-call 143 71.1% 38 18.9% 18 9.0% Is the on-call rota safe i.e. there are sufficient trainees to cover A&E/SAU/elective patients/theatres 119 59.2% 65 32.3% 14 7.0% 13

14. 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

15. 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

16. 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

17. Thank you Any questions?