EDITOR—The reports of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) focus on reducing surgical morbidity and mortality through minimising out of hours operating, limiting “after midnight” operating to absolute emergencies and increasing senior input into cases.1 Acceptable waiting times for such surgery also exist2—that is, emergencies (American Society of Anesthesiologists (ASA) score of 4-5) < 1 h, urgent (ASA score 1-3) < 24 h. Rota changes as a result of the European working time directive potentially influence efficiency in theatre.

Our institution provides a 24 hour emergency operating theatre for urgent or emergency surgery. Anaesthetic cover during daytimes, Monday to Friday, is by consultants. Out of hours and weekend cover is from a two tier trainee rota (compliant with the directive) with on-call support from consultants. Before March 2004 the trainees worked a non-resident 24 hour on-call rota.

To assess emergency theatre use we …