No coin nor oath required. For personal study only.
Aims: Emergency vascular services are provided increasingly by collaborative rotas with transfer of emergencies between hospitals, but 'urgent' patients requiring early attention will continue to be referred to vascular surgeons who are not on call for emergencies and who have a full elective workload. A prospective register of referrals was used to examine the scale of this problem. Methods: Between January 1998 and July 2002, 1650 referrals (965 men, median age 73) were made outside the normal outpatient clinic system to the vascular surgeons in a hospital serving a population of 335 000. These were divided by consensus groups of two trainees and then three consultants into 'emergencies' (requirement for a vascular surgeon without delay) and 'urgent' referrals (could be seen next day). Results: There were 193 (12%) emergencies and 1457 (88%) urgent referrals. Ten emergencies required a surgeon immediately 'on site' (e.g. bleeding on operating table). On average there were 7 referrals per week (0•8 emergencies per week). If the admitting general surgeons had been less experienced in vascular assessment, it was estimated that an additional 116 emergency referrals would have been made -total emergencies 299 (18%): the majority of these were ischaemic lower (65) and upper (25) limbs which were treated conservatively. Conclusion: Only a minority of vascular referrals are true emergencies which might require transfer. Service planning in acute hospitals should recognise the need for early investigation and treatment of urgent vascular referrals, in addition to an emergency rota.
📜 SIMILAR VOLUMES