Consultant-Led Models Can Help Reduce Surgery Complications

The acute care surgery (ACS) model, which is consultant-led, provides a safe surgical environment for patients and is associated with a reduced complication rate, according to an article in the Medical Journal of Australia. Dr Robert Gandy, Surgical Registrar at the Prince of Wales Hospital, Sydney, and co-authors conducted a retrospective historical control study, comparing appendicectomy outcomes for the ACS model with the traditional on-call (Trad) model.

Dr Gandy said that the ACS model, when compared with the Trad model, resulted in reduced complication rates and fewer operations after midnight.

The complication rate was lower in the ACS model than the Trad model (9.3 per cent versus 17.0 per cent).

After the intervention, there was no significant change between the ACS and Trad model in the time from presentation to arrival in theatre or length of stay, but the proportion of operations performed at night was reduced from 22.7 per cent (Trad model) to 17.3 per cent (ACS model).

The ACS model is consultant-led. This means that a higher proportion of patients are reviewed by a consultant before surgery than in the Trad model (54.9 per cent versus 38.1 per cent).

The consultant supervision reduces adverse outcomes without compromising registrar training opportunities, and is likely to reinforce patients’ confidence in their care.

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“By implementing a consultant-led system and a culture in which emergency surgery is prioritised and separated from the elective surgical stream, complications and unnecessary operations after midnight can be reduced”, said Dr Gandy.

The Medical Journal of Australia is a publication of the Australian Medical Association.

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Source-MJA