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NCEOD Report Launch November 11 th 2010

NCEOD Report Launch November 11 th 2010. John MacFie. Association of Surgeons of Great Britain and Ireland EMERGENCY GENERAL SURGERY: PRESENT AND FUTURE. Workload associated with EGS is far in xs of any other speciality

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NCEOD Report Launch November 11 th 2010

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  1. NCEOD Report Launch November 11th 2010 John MacFie

  2. Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE • Workload associated with EGS is far in xs of any other speciality • This speciality (EGS) has attracted little dedicated resource or committment to research or training • Standards of care are often unsatisfactory • Reasons for sub optimal care include: failure to prioritise inadequate senior input poor clinical leadership unsatisfactory resourcing absence of dedicated managers http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

  3. Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE • Emergency general surgery is a huge clinical service (approx 1000 FCEs 100000 pop) • There is evidence to suggest that a committed service reduces litigation, improves workingrelationships and improves outcomes • 3. Provision of EGS requires dedicated resources (PAs, theatre) • Provision of EGS should be by trained surgeons (? Defined subspeciality) • 5. EGS does not require specialist training in major trauma • EGS is not R and R surgery • it is likely that much EGS will be supervised by CCT holders who are not necessarily consultants • 9. EGS does not include any management of acute vascular problems http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

  4. Figure 1: Trends in demand for NHS care (Note: the vertical scale is shown logarithmically to aid comparison between measures of different orders.)

  5. An age old problem • Initial assessment • grade clinician making • diagnosis

  6. An age old problem : delay • evidence to suggest that a delay in performing surgery may • have contributed to deaths

  7. An age old problem : supervision • level of supervision was inadequate in almost a third of cases

  8. An age old problem : pre op assessment • venous thrombosis • peri-operative antibiotics • nutrition

  9. An age old problem : nutrition • nutritional assessment only performed in a minority.... • ...this is likely to have had adverse impact 118/721 height measured 212/730 weight measured 99/723 BMI

  10. An age old problem : MCOP • level of medical input is unsatisfactory

  11. An age old problem : HDU/ICU • it is surprising that a greater number of patients • did not have enhanced care

  12. Association of Surgeons of Great Britain and IrelandEMERGENCY GENERAL SURGERY: PRESENT AND FUTURE • Workload associated with EGS is far in xs of any other speciality • This speciality (EGS) has attracted little dedicated resource or committment to research or training • Standards of care are often unsatisfactory • Reasons for sub optimal care include: failure to prioritise inadequate senior input poor clinical leadership unsatisfactory resourcing absence of dedicated managers http://www.asgbi.org.uk/en/publications/consensus_statements.cfm

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