title: Acute-care surgical service: a change in culture.
abstract: The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia. andrew.parasyn@sesiahs.health.nsw.gov.au
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Parasyn
authors.forename: Philip G
authors.initials: PG
authors.lastname: Truskett
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.forename: Sharon
authors.initials: S
authors.lastname: Lum
authors.forename: Jennie
authors.initials: J
authors.lastname: Barry
authors.forename: Koroush
authors.initials: K
authors.lastname: Haghighi
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Crowe
mesh_terms: D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D009517:New South Wales; D009873:Operating Rooms / Q000706:statistics & numerical data*; D015279:Organizational Culture; D016730:Program Development; D013503:Surgery Department, Hospital / Q000458:organization & administration*