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    Vulnerability of emergency surgery to the working conditions of new doctors

    Kamau, Caroline (2016) Vulnerability of emergency surgery to the working conditions of new doctors. Bulletin of the Royal College of Surgeons 98 (8), pp. 354-357. ISSN 1473-6357.

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    Abstract

    About 30–40% of emergency patients undergo surgery, which has an increased risk of serious complications and death.1 Despite this, newly qualified doctors are often responsible for reviewing patients who present themselves at emergency.2 Up to 90% of patient mortality within 48 hours of admission happens in emergencies3 and this high-risk group can comprise up to 80% of postoperative mortality.4 Staffing and workload issues in emergency departments have been implicated,1 which makes organisational support for new doctors something that is pivotal to the process, although precisely what counts as sufficient staffing in hospitals is under discussion.5 Studies have highlighted the importance of adequate clinical supervision,6 with one study showing that the presence of a consultant is associated with better outcomes after emergency surgery.7 The problem is that consultants in emergency departments are often overloaded with demands. Their workload can average 101 different tasks per hour and two-fifths of their time can be spent communicating with others.8 There is also a serious under-representation of senior doctors whose expertise is emergency surgery1,4 as well as underfunding of research into emergency surgery.9 Emergency surgery is a field of medicine that requires a very high level of expertise to guide urgent decision-making, putting new doctors at risk of delayed or erroneous decision-making. Patients typically arrive with external trauma, acute diseases that are life-threatening or internal bleeding/rupture.10,11 Delays of diagnosis or investigation can therefore be lethal. Some hospitals have put measures in place to address the staffing and organisational process problems, and research has shown that these successfully reduce emergency patient mortality.2 However, there remains concerning variation across hospitals in the standards of emergency surgery care;12 for example, across 35 hospitals, patient mortality after an emergency laparotomy can range from 3.6% to 41.7%.4 As a step towards explaining these organisational differences and identifying a realistic solution, this study examined the interaction of new doctors’ working conditions with surgical and emergency contexts.

    Metadata

    Item Type: Article
    School: Birkbeck Schools and Departments > School of Business, Economics & Informatics > Organizational Psychology
    Depositing User: Caroline Kamau
    Date Deposited: 04 Nov 2016 14:42
    Last Modified: 04 Nov 2016 14:42
    URI: http://eprints.bbk.ac.uk/id/eprint/16427

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