Emergency general surgery - RCS and ASGBI position statement 

In a drive to improve patient care, the Royal College of Surgeons (RCS) and the Association of Surgeons of Great Britain and Ireland (ASGBI) are today setting out their views on the challenges and a way forward for emergency general surgery in the NHS.

Emergency general surgery accounted for 14,000 adult admissions to intensive care in England and Wales in 2011/12, and created intensive care costs of over £88m per year.

Patients requiring emergency surgical assessment or operation are among the sickest in the NHS. Often frail, elderly and with other medical problems, the risk of death or serious complication can be high. The most common complex major emergency operations in adults are those to treat abdominal infections, bowel obstructions, appendicitis and gallstones.

As professional bodies advancing surgical standards, the RCS and ASGBI are concerned about the delivery and future viability of emergency general surgery. Systems within some hospitals are not sufficiently well designed to deal with the safe and efficient delivery of this important area of care. Several factors affect the ability to deliver a good service, from having the right workforce in place through to problems accessing operating theatres and diagnostic services when necessary.

The situation has been exacerbated by the European Working Time Regulations, which stipulate how many weekly hours doctors can work. The reduction in working hours over the past four years has both reduced the availability of surgeons to deal with emergencies and increased the number of handovers required, eroding continuity of patient care.

To improve the care provided to emergency general surgery patients, the RCS and ASGBI recommend that:

• NHS England should establish a strategic clinical network for emergency general surgery to oversee the delivery of safe and efficient care. 
• Best practice tariffs should be developed to reward the delivery of high quality emergency general surgical services.
• Surgical treatment of acutely ill patients must take priority over planned, elective surgery when necessary. 
• Services must be consultant-led and senior doctors must be involved throughout the patient’s care. The seniority of the surgeon involved in the operation must match the clinical need of the patient.
• There should be a greater focus on the outcomes of care, with improved resources for audit and review of practice. Outcomes should be in the public domain. 

A copy of the full report Emergency General Surgery can be found here.

Notes to editors

The RCS and ASGBI are leading the development of commissioning guidance for emergency general surgery which will set out pathways for patients with acute abdominal pain.

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808

For more information, please contact the RCS press office on:

• 020 7869 6047/ 6052 
• communications@rcseng.ac.uk
• Out-of hours: 07966 486 832