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Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted.This study aimed to define a group of important processes during EGS admission and assess their reliability. Literature review and semi-structured interviews were used to define a draft list of processes, which was refined and validated using the Delphi consensus methodology. A prospective cohort study of the 22 included processes was performed in 315 patients across 5 acute hospitals.Prospective study of the 22 selected processes demonstrated omission of 1130/5668 (19.9%) processes. Only 6 (1.9%) patients had all relevant processes performed correctly. Administration of oxygen to hypoxic patients (82/129, 64%), consultant review (202/313, 65%) and administration of antibiotics within 3 h for patients with severe sepsis (41/60, 68%) were performed particularly poorly. There were significant differences in the mean number of omissions per patient between hospitals (F = 11.008, p 

Original publication

DOI

10.1016/j.ijsu.2016.07.002

Type

Journal article

Journal

International journal of surgery (London, England)

Publication Date

08/2016

Volume

32

Pages

143 - 149

Addresses

Imperial Patient Safety Translational Research Centre, Department of Surgery, Imperial College London, London, UK.

Keywords

London Surgical Research Group, Humans, Emergency Treatment, Length of Stay, Patient Admission, Surgical Procedures, Operative, Retrospective Studies, Cohort Studies, Prospective Studies, Reproducibility of Results, Middle Aged, Emergency Service, Hospital, State Medicine, Outcome Assessment (Health Care), London, Female, Male