Can emergency general surgical referrals be reduced? A prospective study.

It has been proposed that early assessment by a senior surgeon would result in a significant reduction in the number of general surgical admissions. A prospective study of 290 surgical patients admitted to a busy district general hospital over a period of 1 calendar month has been performed to test this hypothesis. After admission, all patients were assessed by a senior surgeon who carried out triage for each patient. The commonest diagnoses in descending order of frequency were non-specific abdominal pain, appendicitis, diverticular disease, cholecystitis, head injury and pancreatitis. Twenty-two per cent of emergency admissions underwent emergency surgery. A total of 90.7% of admissions were deemed appropriate, 5.5% were deemed inappropriate and in 3.8% of cases the senior surgeon was uncertain as to whether the patient should be admitted or not. Our data fail to substantiate the claim that a significant reduction in intake size would be achieved by early assessment by a senior surgeon. Assessment by surgeons may mean sacrificing other clinical commitments, and is likely to result in a diminution in the standard of both basic and higher surgical training.