title: Modular acute system for general surgery: hand over the operation, not the patient.
abstract: BACKGROUND
  Various models have been proposed to effectively provide acute surgical care in Australasia. Recently, General Surgeons Australia (GSA) has published a 12-point plan with guiding principles on this matter. This study describes a model of providing acute general surgical care in a high-volume institution, evaluates clinical outcomes and critically appraises the system against the GSA 12-point plan.
  
  
  METHODS
  The acute care system is qualitatively described with quantitative measures of workload. The outcomes of acute laparoscopic cholecystectomy were used as a proxy of system performance. The system was critically appraised against the GSA 12-point plan.
  
  
  RESULTS
  Teams are on call once per week with each surgeon on call once per fortnight. The three key elements of acute management - collecting patients, post-acute ward round and operating - are treated as modules. The patient remains under the care of the admitting consultant but is often operated on by another team. From June 2009 to 2010, there were 7429 acute general surgical admissions (mean: 20.4 patients per day) with 2999 acute operations (mean: 8.4 operations per day). The other activities of the department were not compromised. In that time, 388 acute laparoscopic cholecystectomies were performed with a conversion rate of 1.3% and no major bile duct injury. The system is compatible with the GSA 12-point plan.
  
  
  CONCLUSIONS
  This study describes an efficient and safe system for providing acute general surgical care in a high-volume setting with satisfactory clinical outcomes. It is compatible with the GSA 12-point plan.
authors.affiliation: Department of Surgery, Middlemore Hospital, University of Auckland, New Zealand.
authors.forename: Garth H
authors.initials: GH
authors.lastname: Poole
authors.forename: Tamara
authors.initials: T
authors.lastname: Glyn
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D013502:General Surgery / Q000458:organization & administration* / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D013503:Surgery Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D016526:Workload