The BMJ Awards 2017: Surgery

Better emergency surgical care

Care is better when consultants are there to deliver it, but in emergency surgery this is demanding. “We looked at guidelines from the royal colleges and realised they were impossible to meet using traditional on-call rotas,” says Arin Saha, consultant general and upper gastrointestinal surgeon at Calderdale and Huddersfield NHS Foundation Trust. “Our results, when we compared them with others, were no better and no worse. Of 119 patients who needed emergency laparotomy, the average time from admission to seeing a consultant surgeon was 18 hours.”

The solution was thrashed out between the entire surgical team over the course of several meetings. Instead of on-call rotas they agreed to go on day or night shifts. “With the old rotas, you might be on call at night then be scheduled to work the next day,” he says. “On the new rota if you are working at night you can devote yourself to it knowing that you’ll get the next 12 hours off.”

He admits that for consultants the idea of working nights is “pretty out there” but a trial produced astonishing results. “It quickly fed through into shorter length of stay, lower mortality, and fewer complications.” Elective surgery job plans were modified to allow fallow lists to be filled in a predictable way, with no impact on waiting times.

Mortality from emergency laparotomy has halved (from 12% to 6%), the time taken to see a consultant surgeon is down from 18 hours to five, while length of stay has fallen by 20%. The change cost nothing.

Open fracture management

Open fractures of the lower leg—often the result of car, motorcycle, or cycling accidents—can easily lead to infection, calling for long and complicated treatments that are not always …