General Surgical Registrar in the Emergency Department: Developing and Evaluating a New Surgical Role

Abstract Intro NHS Departments are experiencing unprecedented pressures with exponentially growing patient numbers and severe delays in waiting time. This directly influences bed pressures leading to cancellation of elective surgical lists to aid acute admissions. We introduce the role of a surgical registrar in emergency departments (ED) to review general surgical patients to (i) help reduce ED waiting times (ii) prevent unnecessary admissions and (iii) accelerate management plans. Methods This unique role was introduced in our local ED department for 3 months (Nov 2019 - Jan 2020). The shift was trialled Mon-Fri from midday to 8pm. Patient length of stay (LOS), referral times, admissions, discharges and breaches (> 4hrs) were recorded. Results The admission rate was 24% (n 681), with a 10% reduction compared with preceding months. 75% patients were discharged following review from which 20% had outpatient investigations arranged. Average LOS at time of referral was 1hr37mins. Peak referral activity was observed on Mondays, Fridays and between 2-5pm. 98% underwent investigations and 79% received active treatments. Feedback from stakeholders, including surgical colleagues was favourable as it allowed more time spent on operative activities. Conclusion The NHS has some of the most challenging performance standards in the world. We introduce an innovative solution to help reduce rising clinical and financial pressures. The role of the surgical ED registrar helps reduce waiting times, escalate management and prevent unnecessary surgical admissions. Further studies are being conducted to further evaluate the sustainability of this service and extending it to neighbouring trust hospitals.