Sub-specialization in general surgery: the problem of providing a safe emergency general surgical service

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
J P GarnerM R Thompson

Abstract

The increasing subspecialization of general surgeons in their elective work may result in deskilling and create problems in providing expert care for emergency cases. To evaluate the size of the problem this study determined how often complex emergency surgical cases are treated by general surgeons working outside their own elective subspecialty. In a district general hospital in the south of the UK serving a population of 550 000 where there is almost complete subspecialization within general surgery, 1554 patients having emergency general surgical operations were studied in a one-year review. The time an operation occurred, the seniority of the operating surgeon, the subspecialty interest of the consultant responsible for the case compared with the specialist nature of the operation was determined. Of 1554 patients having emergency general surgical operations, 23% (352/1554) were of a high category of complexity. Ninety were vascular procedures and were dealt with by specialist vascular surgeons on a separate rota. Of the remaining 262 operations, 78 (30%) did not match the subspecialty of the consultant surgeon responsible for their care; 56 (72%) of these occurred out of hours of which 14 (18%) had a consultant surgeon pres...Continue Reading

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Citations

Aug 13, 2011·Hernia : the Journal of Hernias and Abdominal Wall Surgery·H Kulacoglu, D Oztuna
Oct 17, 2013·BMC Medical Education·Andrew P CoveneyHenry P Redmond
Dec 1, 2012·Journal of the American College of Surgeons·Levi ProcterJoseph B Zwischenberger
Jan 7, 2016·World Journal of Emergency Surgery : WJES·L PearceA Macdonald
Jul 14, 2010·ANZ Journal of Surgery·Michael R CoxPatrick Cregan
Jan 22, 2010·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·J Schmidli, F Dick
Oct 6, 2009·Journal of the American College of Surgeons·Rebecca C BrittL D Britt
Dec 26, 2013·The Journal of Trauma and Acute Care Surgery·Jonathan B KoeaHardeep Hundal
Jun 9, 2016·Annals of the Royal College of Surgeons of England·R J EganUNKNOWN Wales Deanery Emergency General Surgery Working Group
Oct 2, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·John YoungRoss C McLean

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