Download Emergency Surgery in Europe: the UEMS perspective

Emergency Surgery in Europe:
the UEMS perspective
Jonathan Tilsed
Chairman UEMS Working Group on Emergency Surgery
• introduction to UEMS
• problems of emergency surgery
• how we plan to improve them
1. UEMS
promotion and harmonisation within the
European Union of the highest level of
• training
• medical practice
• health care
Article 3 UEMS Statutes
• promotion of free movement of medical
specialists within the EU
Article 3 UEMS Statutes
2. THE PROBLEM
Every important hospital should
have on its resident staff of
surgeons at least one who is well
trained and able to deal with any
emergency that may arise
William S. Halsted
(1852-1922)
Where are we now?
• general surgeon
• visceral surgeon
• ‘unfallchirurg’
• acute care surgeon
Does it matter?
4 fundamental principles for
delivering good customer
service:
1 the organisation is fully committed to
providing excellent customer care and
the customer is the key focus
throughout the organisation
2 all staff are aware of and committed to
the vision of excellent customer care
3 all staff are trained to provide the
highest quality customer care
4 systems and procedures are designed
to enhance customer care
• the organisation is fully committed to providing
excellent care for the emergency surgical patient
• the emergency surgical patient is the key focus
throughout the organisation
The Cinderella specialty
Elective surgery:
Emergency surgery:
all staff are trained to provide the highest quality
care for the emergency surgical patient
Who are the surgeons “on call” for Surgical Emergencies?
USUALLY A “CONTRACTUAL OBLIGATION”
20% of advertised surgical consultant posts in the UK in the past
2 years were for Emergency General Surgeons
- a sub-specialty that has no definition and is not recognized
by any of the Surgical Colleges
Acute Care Surgery in Europe:
Acute Care Surgery in Europe:
a) Skeletal trauma
•Orthopedist (Finland, France, Italy, Norway, Portugal,
Romania, Spain, Turkey and United Kingdom)
•A trauma or general surgeon (Croatia, Luxembourg,
and The Netherlands)
•A trauma or orthopedic surgeon (Czech Republic and
Germany)
•General surgeon (Greece and Switzerland)
b) Visceral trauma
•General surgeon (Austria, Croatia, Finland, Greece,
France, Italy, Luxembourg, The Netherlands, Norway,
Portugal, Romania, Switzerland, Spain, Turkey, and
United Kingdom)
•Visceral and/or trauma surgeon (Czech Republic,
Germany, and Slovenia)
c) Abdominal emergencies
•General surgeons (Austria, Croatia, Greece, Finland,
Italy, Luxembourg, The Netherlands, Norway, Portugal,
Romania, Spain, Switzerland, Turkey and United
Kingdom)
•Visceral/abdominal surgeons (Czech Republic and
France)
•Visceral/trauma surgeon (Germany, The Netherlands,
and Slovenia)
•Traumatologist/trauma surgeon (Austria and Slovenia)
d) Thoracic emergencies
•Thorax surgeons (Czech Republic and Finland)
•Thorax or general surgeons (Austria, Croatia, Greece, Italy,
Portugal, Romania, United Kingdom)
•Visceral surgeons (France)
•Trauma or thorax surgeons (Germany, The Netherlands, and
Slovenia)
•General surgeons (Norway, Spain, Switzerland, and
Turkey)
e) Vascular emergencies
•Vascular surgeons (Czech Republic, Finland, Greece, Italy,
Spain and United Kingdom)
•Vascular or general surgeons (Austria, Croatia, Luxembourg,
Portugal, Romania, Slovenia, Switzerland, and Turkey)
•Visceral, orthopedic or vascular surgeons (France)
•Trauma or vascular surgeons (Germany and The
Netherlands)
•General surgeons (Norway)
Even acute care surgery has distinctions:
Emergencies:
Urgent:
immediate threat to life, limb or
organ
within 6 hours
Questionnaire
10 questions
• which country ?
• who operates on:
–
–
–
–
–
–
–
–
skeletal injuries
visceral injuries
vascular injuries
chest injuries
head injuries
burn injuries
urinary tract injuries
the Acute abdomen
• who manages the polytrauma or acutely ill surgical
patient on ITU ?
10 responses
•
•
•
•
•
•
•
•
•
•
country – drop down box
trauma surgeon
general surgeon
acute care surgeon
vascular surgeon
thoracic surgeon
plastic surgeon
neurosurgeon
anaesthetist/intensivist
other – free text
Survey
•
•
•
•
questionnaire to 102 contacts
61 replies
52 countries
43 unique responses!
Albania
Finland
Kuwait
Saudi Arabia
Argentina
France
Latvia
Slovak Republic
Australia
Georgia
Macedonia
Slovenia
Austria
Germany
Malta
South Korea
Belgium
Greece
Moldova
Spain
Brazil
Hong Kong
Netherlands
Sudan
Bulgaria
Hungary
Nigeria
Sweden
Czech Republic
India
Norway
Switzerland
Chile
Iraq
Pakistan
Turkey
Croatia
Israel
Portugal
Ukraine
Cyprus
Italy
Qatar
United Arab Emirates
Denmark
Japan
Romania
United Kingdom
Ecuador
Jordan
Russian Federation
United States
52 countries surveyed
General Surgeon
Trauma surgeon
Acute care surgeon
98%
48%
17%
Who is the emergency surgeon?
General surgeon
23
(44%)
Trauma surgeon
13
(25%)
Highly specialised
10
(19%)
Trauma or General surgeon 5
(10%)
Unclassifiable:
1
( 2%)
Total
52
(100%)
Highly-specialised (19%)
Is the general surgeon being deskilled?
Acute abdomen and
abdominal trauma
31%
Acute abdomen only – no
visceral trauma
6%
Acute abdomen and
urinary tract injury
2%
What does the trauma* surgeon do?
Skeletal trauma only:
25
(51%)
Skeletal & visceral trauma: 12
(24%)
Skeletal trauma & burns:
4
( 8%)
No skeletal trauma:
8
(16%)
Total:
49
(100%)
*Includes orthopaedic surgeon where no
trauma surgeon specified
What about the Acute Care Surgeon?
•
•
•
•
•
•
•
•
Switzerland:
USA:
Sweden:
Moldova:
Sudan:
Italy:
UAE:
Jordan
& Australia:
does everything
general surgeon who does burns & ITU
same as general surgeon except no burns
same as trauma surgeon
skeletal injury only
no skeletal or intracranial trauma
no urological or intracranial trauma
ITU only – non-operative
What can they do?
Acute Care Surgeon
General Surgeon
Trauma Surgeon
Thoracotomy
22%
49%
68%
Vascular trauma
33%
35%
68%
Urinary tract
injury
22%
39%
40%
Burns
44%
33%
36%
Intracranial injury
11%
10%
20%
Countries:
17%
98%
48%
3. THE EM SURG WORKING GROUP
In Europe
• different focus of care
• different levels of training
• different systems development and maturation
a flexible training model, based on local organization
and patients needs is required
Ideal solution:
•
•
•
•
•
set standards
develop a training programme
identify and accredit training units
deliver the training programme
test the trainees on completion of the programme
I suppose Ireland is the best
place in the world for
directions. People will say to
you "I wouldn't start from
here if I were you."
Dave Allen
1936-2005
Pragmatic solution:
• agree standards
– national opt-outs
• test
• develop a training programme
• deliver training programme
• accredit training units
Emergency Surgery
a transferable competence
General surgeons
Austria
Finland
The
Netherlands
Romania
Turkey
Croatia
Italy
Norway
Spain
United Kingdom
Greece
Luxembourg
Portugal
Switzerland
Visceral / abdominal
surgeons
Czech Republic
France
Visceral / trauma surgeons
Germany
The Netherlands
Slovenia
Emergency Surgery
• a transferable
competence
- national exemptions
not lowest common
denominator
Emergency Surgery
a transferable competence
not starting again ……
building on what we have
Conclusion
• organisation of emergency surgical care is complex
• training surgeons to provide emergency care is challenging
• a flexible training model to accommodate international
differences and improve standards may be the solution
• a transferrable competence will be easier to implement
than a new specialty
Thank you!