Vascular surgical society of great britain and ireland: provision of an emergency vascular service: a three-hospital model
BACKGROUND: A new emergency vascular cover service came into effect on 1 May 1997 involving three district general hospitals, eight surgeons and covering a patient population of 600 000. Each week one of the three hospitals is on call, accepting the transfer of patients requiring urgent surgical or radiological vascular intervention between 17.00 and 09.00 hours each weekday and throughout the weekend from the other two hospitals. The aim of this project was to evaluate the pattern, appropriateness of referral and increased workload in the first year following the implementation of this model of emergency vascular cover. METHODS: A retrospective study of case notes was conducted identifying all acute vascular emergency admissions from each hospital. RESULTS: The total number of emergency admissions when on call was 140; 71 per cent were admitted via bed bureau/accident and emergency, 26 per cent were transfers from the other two hospitals and 3 per cent were transfers from elsewhere. Some 66 per cent of admissions occurred between 17. 00 and 09.00 hours or at weekends; 36 per cent required emergency operation. Of these patients, 42 per cent required abdominal aortic aneurysm repair, 42 per cent an embolectomy, 11 per cent an amputation and 5 per cent another procedure. Consultants performed 58 per cent of the emergency operations, specialist registrars 37 per cent and senior house officers 5 per cent. Of the total number of emergencies admitted, 12 per cent required intensive care unit facilities. Some 63 per cent of the patients were finally discharged, 11 per cent were transferred and 25 per cent died. CONCLUSION: These data demonstrate that one consultant-led vascular team can provide an out-of-hours emergency vascular service for a population served by three hospitals. The workload is manageable without the predicted drain on resources and is preferred by the participating consultants.