Abstract
During the 1980s there has been increasing concern about hospital medical staffing. Achieving a Balance will lead to a reduction in the number of registrars and a possible increase in the work done out-of-hours by consultants. The deleterious effects of long hours of work have also attracted attention and, in particular, there is concern about the safety of operations performed at night by unsupervised junior doctors. There is an urgent need to examine how out-of-hours work can be reduced. This study was conducted in two phases. The out-of-hours surgical workload in four hospitals was examined. Appropriateness of the procedures and activities being carried out was then considered by a consensus panel, aided by a literature review. Most out-of-hours operations were performed by junior staff. The principal reasons suggested for operating at night are lack of day-time theatre space and the need to gain experience. There was considerable variation in the frequency with which different types of operation were performed among hospitals. The views of the panel suggest that up to one-third of operations currently performed at night could be postponed. It may be possible to postpone a higher proportion of operations performed after midnight. The appropriateness of the remaining operations has major implications for the work of consultants following the implementation of Achieving a Balance.
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Selected References
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- Adams I. D., Chan M., Clifford P. C., Cooke W. M., Dallos V., de Dombal F. T., Edwards M. H., Hancock D. M., Hewett D. J., McIntyre N. Computer aided diagnosis of acute abdominal pain: a multicentre study. Br Med J (Clin Res Ed) 1986 Sep 27;293(6550):800–804. doi: 10.1136/bmj.293.6550.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Buchman T. G., Zuidema G. D. Reasons for delay of the diagnosis of acute appendicitis. Surg Gynecol Obstet. 1984 Mar;158(3):260–266. [PubMed] [Google Scholar]
- Davis S. E., Sperling L. Obstruction of the small intestine. Arch Surg. 1969 Oct;99(4):424–426. doi: 10.1001/archsurg.1969.01340160004002. [DOI] [PubMed] [Google Scholar]
- Flook D. J., Crumplin M. K. The efficiency of management of emergency surgery in a district general hospital--a prospective study. Ann R Coll Surg Engl. 1990 Jan;72(1):27–31. [PMC free article] [PubMed] [Google Scholar]
- Gunn A. A. The diagnosis of acute abdominal pain with computer analysis. J R Coll Surg Edinb. 1976 May;21(3):170–172. [PubMed] [Google Scholar]
- Hurst J., Curson J. A. Cost of achieving a balance in the anaesthetic department of a district general hospital. BMJ. 1988 Oct 22;297(6655):1033–1034. doi: 10.1136/bmj.297.6655.1033. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nauta R. J., Magnant C. Observation versus operation for abdominal pain in the right lower quadrant. Roles of the clinical examination and the leukocyte count. Am J Surg. 1986 Jun;151(6):746–748. doi: 10.1016/0002-9610(86)90057-7. [DOI] [PubMed] [Google Scholar]
- Parkhouse J., Bennett D., Ross J. Medical staffing and training in the West Midlands region. Br Med J (Clin Res Ed) 1987 Apr 4;294(6576):914–916. doi: 10.1136/bmj.294.6576.914. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Parkhouse J., O'Brien J. M. Medical and dental training and staffing in a region--the long and short of it. Br Med J (Clin Res Ed) 1984 Jun 9;288(6432):1773–1775. doi: 10.1136/bmj.288.6432.1773. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sherlock D. J., Randle J., Playforth M., Cox R., Holl-Allen R. T. Can nocturnal emergency surgery be reduced? Br Med J (Clin Res Ed) 1984 Jul 21;289(6438):170–171. doi: 10.1136/bmj.289.6438.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stewardson R. H., Bombeck C. T., Nyhus L. M. Critical operative management of small bowel obstruction. Ann Surg. 1978 Feb;187(2):189–193. doi: 10.1097/00000658-197802000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomson H. J., Jones P. F. Active observation in acute abdominal pain. Am J Surg. 1986 Nov;152(5):522–525. doi: 10.1016/0002-9610(86)90220-5. [DOI] [PubMed] [Google Scholar]