Introduction
Materials and methods
Search strategy
Selection of articles
Data extraction
Relevant structural components of ACS models |
---|
∙ Region/country |
∙ Type of model |
∙ Dedicated team: yes/no |
∙ Dedicated unit: yes/no |
∙ Elective duties of attending surgeon |
∙ Dedicated operating room (OR) access |
∙ Service coverage |
∙ ED coverage |
∙ Trauma coverage |
∙ Critical care coverage |
Quality assessment
Results
Study characteristics
Author | Year | Country | Study design | Model | NOS Score | Quality rating |
---|---|---|---|---|---|---|
Beardsley et al. [37] | 2013 | Australia | Retrospective | SAPU | 6 | Low |
Cox et al. [38] | 2010 | Australia | Report | ASU | – | – |
Dickfos et al. [39] | 2017 | Australia | Retrospective | RAMS | 5 | Low |
Lancashire [43] | 2014 | Australia | Retrospective | ASU | 6 | Low |
Allaway et al. [36] | 2017 | Australia | Retrospective | ASU | 6 | Low |
Gandy et al. [40] | 2010 | Australia | Retrospective | ACS | 6 | Low |
Guy et al. [41] | 2018 | Australia | Retrospective | ASU | 6 | Low |
Kinnear et al. [42] | 2017 | Australia | Retrospective | ASU | 7 | Med |
Lehane et al. [44] | 2010 | Australia | Retrospective | ACS | 6 | Med |
Musiienko et al. [45] | 2016 | Australia | Retrospective | ASU | 8 | High |
Parasyn et al. [46] | 2009 | Australia | Retrospective | ACS | 5 | Low |
Pepingco et al. [47] | 2012 | Australia | Retrospective | ASU | 6 | Low |
Shakerian et al. (Br J Surg) [49] | 2015 | Australia | Retrospective | ASU | 8 | High |
Shakerian et al. (2) (World J Surg) [48] | 2015 | Australia | Retrospective | ASU | 8 | High |
Suhardja et al. [50] | 2015 | Australia | Retrospective | ASU | 6 | Low |
Von Conrady et al. [51] | 2010 | Australia | Retrospective | ASU | 6 | Low |
Wang et al. [52] | 2018 | Australia | Financial analysis | ASU | – | – |
Suen et al. [53] | 2013 | Australia | Retrospective | EGS | 6 | Low |
Poggetti et al. [35] | 2009 | Bra/Fin/USA | Descriptive | – | – | – |
Anantha et al. [29] | 2015 | Canada | Retrospective | ACCESS | 6 | Low |
DeGirolamo et al. [30] | 2018 | Canada | Multicenter observational | EGS | – | – |
Faryniuk et al. [31] | 2013 | Canada | Retrospective | ACSS | 6 | Low |
Kreindler et al. [32] | 2012 | Canada | Retrospective | ACS | 7 | Med |
Lim et al. [9] | 2013 | Canada | Retrospective | ACS | 6 | Low |
Qureshi et al. [15] | 2013 | Canada | Pre–post | ACCESS | 6 | Low |
Van Zyl et al. [33] | 2018 | Canada | Prospective | ACS | 8 | High |
Wanis et al. [34] | 2014 | Canada | Retrospective | ACS | 6 | Low |
Hsee et al. (World J Surg) [54] | 2012 | New Zealand | Retrospective | ASU | 6 | low |
Hsee et al. (ANZ J Surg) [55] | 2012 | New Zealand | Descriptive | ASU | – | – |
Pillai et al. [56] | 2013 | New Zealand | Retrospective | ASU | 6 | Low |
Poh et al. [57] | 2013 | New Zealand | Retrospective | ASU | 6 | Low |
Poole et al. [58] | 2011 | New Zealand | Descriptive | ACS team | – | – |
Mpirimbanyi et al. [69] | 2017 | Rwanda | Cross-sectional | – | – | – |
Mathur et al. [65] | 2018 | Singapore | Retrospective | ESAT | 6 | Low |
Al Ayoubi et al. [64] | 2012 | Sweden | Quality control | ACST Unit | – | – |
Fu et al. [66] | 2014 | Taiwan | Pre–post | ACS | 6 | Low |
Dresser et al. [70] | 2017 | Uganda | Descriptive | ECP | 6 | Low |
Bokhari et al. [59] | 2015 | UK | Audit | ESU | 6 | Low |
Bokhari et al. [60] | 2016 | UK | Retrospective | ESU | 7 | Med |
Navarro et al. [61] | 2017 | UK | Retrospective | STU | 6 | Low |
Sorelli et al. [62] | 2008 | UK | Retrospective | Dedicated EGS surgeon | 6 | Low |
Tincknell et al. [63] | 2009 | UK | Audit | EST | – | – |
Santry et al. [26] | 2015 | USA | Survey | ACS/On-call/Hybrid | – | – |
Austin et al. [5] | 2005 | USA | Retrospective | EGS | 6 | Low |
Barnes et al. [10] | 2011 | USA | Retrospective and questionnaire | ACS | – | – |
Britt et al. [6] | 2009 | USA | Retrospective | ACS | 6 | Low |
Bruns et al. [13] | 2016 | USA | Retrospective | ACES | 5 | Low |
Cherry-Bukowiec et al. [12] | 2012 | USA | Retrospective | NTE | 6 | Low |
Ciesla et al. [7] | 2011 | USA | Retrospective | ACS | – | – |
Cubas et al. [14] | 2012 | USA | Retrospective | ACS | 6 | Low |
Diaz et al. [16] | 2011 | USA | Retrospective | ACS | 6 | Low |
Ekeh et al. [17] | 2008 | USA | Retrospective | ACS | 6 | Low |
Garland et al. [27] | 2007 | USA | Retrospective | ACS | – | – |
Ladhani et al. [28] | 2018 | USA | Retrospective | EGS | 7 | Med |
Matsushima et al. [8] | 2011 | USA | Retrospective | ACS | 8 | High |
Miller et al. [18] | 2012 | USA | Retrospective | ACS | 4 | Low |
Procter et al. [19] | 2013 | USA | Financial analysis | ACS | – | – |
Pryor et al. [20] | 2004 | USA | Retrospective | EGS | 6 | Low |
Santry et al. [25] | 2014 | USA | Interview analysis | ACS | – | – |
Sweeting et al. [11] | 2013 | USA | Financial analysis | ACS | – | – |
Moodie [68] | 2015 | RSA | Audit | ACGSU | – | – |
Klopper et al. [67] | 2017 | RSA | Retrospective | ACGSU | – | – |
Region/country | ACS model | Dedicated team | Dedicated unit | Elective duties surgeon | Dedicated OR access | Coverage | ED coverage | Trauma coverage | Critical care coverage | |||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Daytime | Night | |||||||||||
Sur | Res | Sur | Res | |||||||||
North America | ||||||||||||
USA | Yes | Varied | Varied | Varied | In-house | Not reported* | In-house | Not reported* | Varied | Included | Included | |
NTE [12] | Yes | Not reported* | Not reported* | Not reported* | In-house | Not reported* | Not reported* | Not reported* | Not reported* | Not included | Not included | |
EGS and trauma service [20] | Yes | Yes | Not reported* | Not reported* | In-house | In-house | On-call | In-house | Yes | Included | Included | |
Canada | Yes | No | Daytime | Daytime | In-house * | Not reported* | Not reported* | Not reported* | No | Not included | Not reported* | |
South America | ||||||||||||
Brazil [35] | None | No | No | Not reported* | Not reported* | Not reported* | Not reported* | Not reported* | Not reported* | Not reported* | Included | Not included |
Australasia | ||||||||||||
Australia/New Zealand | Yes | No | Cleared | Yes | In-house | In-house | On-call | In-house | Not reported* | Varied | Not included | |
Australia | SAPU [37] | Yes | Yes | Not reported* | Yes | On- call | In-house | On-call | In-house | Yes | Not reported* | Not reported* |
Australia | RAMS [39] | No | Yes | No | No | On-call | Not reported* | Not reported* | Not reported* | Not reported* | Not included | Not Reported* |
Australia | Yes | Yes | Yes | Yes | In-house | In-house/not reported* | No/on-call | On-call/not reported* | Yes/Not reported* | Not included/not reported* | Not reported* | |
Europe | ||||||||||||
United Kingdom | Yes | Yes | Yes | Yes | In-house | Not reported* | On-call | Not reported* | Not reported* | Not included | Not reported* | |
STU [61] | Yes | Yes | n/a** | n/a** | In-house | In-house | On-call | In-house | Yes | n/a** | n/a** | |
Single dedicated EGS surgeon [62] | Yes | Yes | Yes | Yes | In-house | In-house | On-call | Not reported* | Yes | Not reported* | Not reported* | |
EST [63] | Yes | Yes | Yes | Yes | In-house | In-house | On-call | In-house | On-call | Not included | Not reported* | |
Sweden | ACST Unit [64] | Yes | Yes | Shared | Shared | In-house | In-house | On-call | In-house | Yes | Included | Included |
Finland | Traditional on-call [35] | – | – | – | – | – | – | – | – | – | – | – |
Asia | ||||||||||||
Singapore | ESAT [65] | Yes | Yes | Not reported* | Not reported* | In-house | Not reported* | On-call | Not reported* | Not reported* | Included | Not reported* |
Taiwan | ACS (single surgeon) [66] | No | No | Not reported* | Not reported* | In-house | Not reported* | In-house | Not reported* | Yes | Included | Not reported* |
Africa | ||||||||||||
South Africa | Yes | Yes | No | No | In-house | In-house | On-call | In-house | Yes | Not included | Not included | |
Rwanda | None [69] | – | – | – | – | – | – | – | – | – | – | – |
Uganda | None (ECP) [70] | – | – | – | – | – | – | – | – | – | – | – |
North America
South America
Australasia
Europe
United Kingdom (UK)
Continental Europe
Asia
Africa
Discussion
1 | Emergency general surgery is a continuing core competency of a general surgeon |
2 | Emergency general surgery should be consultant led |
3 | There should be dedicated staff allocated to the provision of emergency care, with the need for training recognized |
4 | There should be separation of emergency general surgery and elective general surgery systems |
5 | There should be appropriate and timely access to emergency operating theaters |
6 | Emergency operations should be performed during the working day unless there is threat to life, limb, or organ |
7 | Consultant (attending) surgeons should contribute to the efficient management of emergency theater |
8 | The period of service of the emergency general surgeon must be defined. Work practices must reflect safe hours principles |
9 | There must be robust handover and transfer of care: peer to peer, documented and retrievable |
10 | Best practice should be defined. Quality should be measured by clinically meaningful Key Performance Indicators (KPI’s) |
11 | The service must reflect community need and regional variation |
12 | The service must be valued (recognized, rewarded, resourced, and renumerated) |