title: Can emergency general surgical referrals be reduced? A prospective study.
abstract: It has been proposed that early assessment by a senior surgeon would result in a significant reduction in the number of general surgical admissions. A prospective study of 290 surgical patients admitted to a busy district general hospital over a period of 1 calendar month has been performed to test this hypothesis. After admission, all patients were assessed by a senior surgeon who carried out triage for each patient. The commonest diagnoses in descending order of frequency were non-specific abdominal pain, appendicitis, diverticular disease, cholecystitis, head injury and pancreatitis. Twenty-two per cent of emergency admissions underwent emergency surgery. A total of 90.7% of admissions were deemed appropriate, 5.5% were deemed inappropriate and in 3.8% of cases the senior surgeon was uncertain as to whether the patient should be admitted or not. Our data fail to substantiate the claim that a significant reduction in intake size would be achieved by early assessment by a senior surgeon. Assessment by surgeons may mean sacrificing other clinical commitments, and is likely to result in a diminution in the standard of both basic and higher surgical training.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Bowrey
authors.forename: J M
authors.initials: JM
authors.lastname: Wheeler
authors.forename: R O
authors.initials: RO
authors.lastname: Evans
authors.forename: L J
authors.initials: LJ
authors.lastname: Fligelstone
authors.forename: K D
authors.initials: KD
authors.lastname: Vellacott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data; D006113:United Kingdom; D019564:Unnecessary Procedures