Emergency General Surgery

Patients requiring emergency surgical assessment or treatment are among the most unwell patients in the NHS. Often elderly, frail and with significant other health problems, the risk of death or serious complication is unacceptably high.

In July 2014 the Royal College of Surgeons (RCS), Royal College of Emergency Medicine and other medical royal colleges published a report setting out 13 recommendations on how to make the emergency care system more sustainable and resilient. 

The College outlined the main challenges facing emergency surgery in its September 2014 policy briefing.

Improving emergency general surgical services

Cholecystectomy Quality Improvement Collaborative (Chole-QuIC)

The College has started a project focusing on one area of emergency general surgery, which aims to:

• reduce variability in outcomes and improve quality of care for patients with acute gallstone disease;
• using expert facilitation and quality improvement (QI) methodology, support clinicians and hospitals to drive service improvement;
• develop a translatable model for improving the quality of surgical care.

The project is now up and running, with a cohort of 13 hospitals participating in the collaborative, and is set to complete in January 2018. Find out more about the Chole-QuIC project.

There are several other initiatives which seek to improve emergency surgical services:

• The National Emergency Laparotomy Audit aims to improve the quality of care for patients undergoing this procedure through the provision of high quality comparative data from all providers of emergency laparotomy.
• The Enhanced Peri-Operative Care for High-risk Patients (EPOCH) trial is a large clinical trial of the effectiveness of a quality improvement project to implement a robust and evidence-based integrated care pathway (ICP) to improve patient outcomes following emergency laparotomy. The ICP is based on that published in the College’s The Higher Risk General Surgical Patient: towards improved cared for a forgotten group.
• The High Risk General Surgical Patient report identifies key issues, sets standards and makes recommendations for adult patients undergoing high-risk emergency or elective abdominal surgery for a broad range of conditions.