The effect of introducing a dedicated emergency theatre and altering consultant on-call commitments in a large children's hospital.

BACKGROUND

Two recommendations of NCEPOD were the introduction of dedicated emergency theatres and a higher level of consultant involvement in emergency cases. In May 1998 a dedicated emergency theatre was introduced in the Royal Hospital for Sick Children, Glasgow. At the same time the on-call rota of the Consultant Paediatric Surgeons was changed from days on-call to a period of one week, during which elective commitments were cancelled.

METHOD

A retrospective audit was conducted for the 12-month periods before and after these changes. Start times of emergency cases and grades of surgeons were obtained from the theatre database.

RESULTS

The proportion of emergency operations carried out during on call periods (weekends and weekdays after 5 pm) decreased for general paediatric and neonatal surgery (OR = 0.7, p < 0.01). There was an increase in the proportion of daytime emergency cases performed before 1 pm (OR = 0.28, p < 0.01). The Consultant Paediatric Surgeons were involved in more emergency cases (OR = 0.60, p < 0.01).

CONCLUSIONS

The provision of a dedicated emergency theatre increased the proportion of emergency cases performed during normal working hours, particularly before 1 pm. Cancelling elective commitments for Consultant Paediatric Surgeons ensured higher levels of consultant input into daytime emergency cases.