When carrying out emergency work, you should:

• Proactively support your organisation’s provisions to ensure that patients receive high quality emergency care.
• Be familiar with formalised pathways for unscheduled care set out by your trust or health board, including risk-grading strategies.
• Accept responsibility for the assessment and continuing care of every emergency patient admitted under your name unless, or until, they are formally transferred to the care of another doctor.
• Be available either within the hospital or within a reasonable distance of the hospital to give advice throughout your duty period.
• Ensure that you are able to respond promptly to a call to attend to an emergency patient. If you are on call in a specialty with a high emergency workload you should be free of all other commitments, including elective commitments and private sector responsibilities. This arrangement should be formally reflected in your job plan.
• Ensure that there are written protocols for the initial management of emergency patients and for the subsequent safe transfer to another team or unit when the complexity of the patient’s condition is beyond the experience of the admitting surgeon or beyond the resources available for the proper care of the patient.
• Ensure that the risk of complication and mortality is fully assessed and understood and effectively communicated to the patient and the wider care team before delegating to another colleague. When there is high risk of mortality and complication, ensure that a consultant surgeon is present and closely involved in the patient’s care.
• Delegate assessment of emergency surgical operations only when you are sure of the competence of those to whom the patient’s operative care will be delegated.
• Ensure that emergency patients are reviewed by an on-site consultant surgeon at least once every 24 hours and more often if the patient is at high risk.
• Ensure that rotas are published well in advance and cooperate with colleagues so that any alternative cover arrangements are specifically made, clearly understood and adequate to provide equivalent care.
• Ensure the formal handover of patients to an appropriate colleague following periods on duty, as described in section 3.4.
• Taking into account the patient’s best interest ensure that, in an emergency, you only perform unfamiliar operative procedures if there is no safe clinical alternative, if there is no colleague available who is more experienced, or if after consultation with the nearest specialist unit transfer is considered a greater risk to the patient.
• If unexpected circumstances require colleagues to act beyond their practised competencies, you should provide support in making the care of the patient the first concern.

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