Improving the efficiency of the emergency general surgical service.

Objective To improve the quality and efficiency of our emergency surgical service. Methods Until 2007, the surgical on-call in our unit was run on a 'consultant of the day' model with triage in a 10-bed surgical receiving unit (SRU) before admission to the wards. The reduction in junior doctors' hours meant little continuity and delays in care. In July 2007, the SRU was expanded and a daily on-ward ultrasound session was established. The consultant rota was changed to a split-week model with twice-daily SRU ward rounds, allowing unstable patients regular senior assessment. Results As a result of the change, our acute length of stay reduced from 4.4 to 3.8 days and our actual versus expected length of stay was the best figure country-wide. Conclusion Early consultant review and swift ultrasound assessment reduce admissions and patient stay. We have combined these factors in our emergency service and have delivered significant cost savings and improved care. European Journal of Emergency Medicine 18:261-264 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.