Safety of emergency surgery services 'a matter of concern'

RSCI vice-president Professor Deborah McNamara: Access to high-quality emergency surgical care is lifesaving and must be available to everyone.'

Ireland should have fewer hospitals offering 24/7 emergency surgery and instead run a network of emergency centres to give patients better care.

An in-depth review of emergency surgery by the Royal College of Surgeons Ireland further warned about the safety of existing services as “a matter of concern”.

RSCI vice-president Professor Deborah McNamara said: “Access to high-quality emergency surgical care is lifesaving and must be available to everyone. 

“A networked system of emergency surgical care enables most emergency surgical care to be delivered as near as possible to the patient’s home while ensuring equitable access to complex care when required.” 

The working group recommended networks include injury units, emergency surgery units, emergency surgery centres for more complex care and be supported by an elective hospital that does not take emergencies.

There should be clearly written pathways between the different units so patients are more swiftly sent to the appropriate place, the 'Surgery for Ireland' report, published on Friday, states.

It recommends emergency care networks be geographically aligned to regional health areas which will come into place next year under the overall Sláintecare plans.

“A reduction in the number of hospitals providing 24/7 emergency surgery is required,” the report found.

“Access to emergency surgery can be preserved in a large number of hospitals, for example from 8am to 8pm, without the requirement for the availability of overnight surgical activities.” 

For patients, this would mean “equitable regional access to higher-quality emergency surgical services locally”.

Currently, patients are experiencing “unprecedented and unacceptable” waiting times for elective surgery linked to the pandemic, the report states.

“Delivering out-of-hours unscheduled surgery at fewer hospital sites is critical to enable our health service to address the unmet need for scheduled surgery,” the report found.

Hospitals without emergency departments are “an important resource”, as patients going there are unlikely to be postponed during crises, the researchers said.

There are plans for three more such hospitals in Glanmire, Co Cork, Galway, and Dublin.

It raised concerns around staffing, saying: “A significant percentage of the existing emergency general surgery service is delivered by breast surgeons.” 

These surgeons are now leaving general work, reflecting similar changes in the UK. The report calls for this to be managed properly to avoid risks for patients.

The authors warn: “The safety of existing emergency general surgery services in a rapidly changing discipline was flagged as a matter of concern.” 

They called for agreement on surgeon numbers, with current rostering practices, especially in regional hospitals “neither practicable nor acceptable”.

The networks need specialist nurses and other medical staff, with 24/7 access to radiology and endoscopy, the report found.