Acute Surgery Out of Hours across Leeds Teaching Hospitals

Publication: 02/08/2018  --
Last review: 01/01/1900  
Next review: 02/08/2021  
Standard Operating Procedure
CURRENT 
ID: 5630 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Acute Surgery Out of Hours across LTHT

This guidance refers to all patients who require out of hours surgery across theatres in LTHT

Many opportunities are available for patients to have emergency surgery in LTHT both in and out of hours:

LGI:
Jubilee Wing-Adult Surgery:
Acute theatres-24/7-theatre staff who work on shifts
Trauma theatre-24/7 -theatre staff who work shifts
Neuro theatre-24/7 -theatre staff who work shifts
Cardiac theatre-24/7 -staff are called in for emergencies
Clarendon Wing-All surgery for Children:
 24/7-staff work shifts
Hand Unit-hand trauma-08.00-18.00 shift pattern

SJUH:
Geoffrey Giles Theatres:
1X 24/7-Staff work shifts
1X 08.00-18.00-staff work shifts
Liver transplant theatre-24/7 but staff are called in for cases.

Trainees in surgery and anaesthesia also work on a shift pattern to cover services 24/7.

For patients who may require surgery after 6pm and before 8am:

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Consider the acuity according to CEPOD classification:

Immediate - Life and limb- require surgery in minutes to an hour
Urgent - clinically deteriorating patient- surgery with-in hours
Expedited - next available list or next few days
Elective - at a pre-planned time

Generally all disciplines of staff should be refreshed and ready to work when they arrive for a night shift.  After midnight, however, as standard practice, consider the risks and benefits to the patient of waiting until the morning acute lists start the following day. Also consider capacity for further life and limb operating should the case go ahead.

In addition, as with all operating, the patient must be prepared for theatre, an appropriate safe post-operative environment must be available and laboratory and radiology services must be available when needed.

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What to do after the decision is made to list the patient for a procedure out of hours:

Book the patient according to theatre booking system in the suite, using appropriate booking form.  
Have a clinician to clinician discussion with the anaesthetist about the patients’ clinical condition and the planned procedure.

The anaesthetist will visit the patient and prioritise case. They will review whether further capacity needs to be created and consider asking for senior help and /or escalating the requirement for a second or third theatre if needed.
In some situations, after collaborative discussion, the patient may be listed as the “golden patient” for first thing on the next daytime acute list.

The decision to operate out of hours is clear and agreed most of the time. Occasionally the decision is more difficult, for example, when the patient is able to wait a certain length of time but could not afford to be bumped further by a more sick patient the next day-see worked examples. In these situations it is reasonable to continue over night with the case provided there is a clear escalation plan should a second sick patient require surgery unexpectedly.

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Worked examples

e.g. Patient with retained products of conception for whom surgical treatment has been deemed appropriate;
Initially the case would be considered as expedited and may done on next day time list
Continues to bleed and requires IV fluids to correct hypovolaemia, may need transfusion if not done

  • category changes to urgent-may be done out of hours.

e.g. Patient with perianal abscess:
Initially planned for a day time list but other emergencies keep bumping patient until later. Abscess becomes more symptomatic-requirement for regular analgesia. Risk of systemic sepsis.  Prolonged  fasting.
Consider risks and benefits of out of hours operating for the patient-relieves symptoms, reduces need for analgesia and enables mobilisation. Patient can eat and can be discharged home more quickly if procedure is performed.

Consider risks and benefits for other patients-patient becomes lower dependency on the ward because their pain has been resolved. They can be discharged earlier. The risk of blocking theatre is low because it is a short case.

The staff are working shifts and have had adequate meal and rest breaks.

  • may be done out of hours

When the criteria for safe operating are not satisfied and there are a large number of acutes booked, it may be necessary to create capacity the next day by cancelling elective procedures. This decision should be made by using the local escalation plan for each operating suite (Jubilee Wing/Geoffrey Giles/Clarendon Wing) in conjunction with the matron for the area, the lead clinicians for the relevant services and business managers as appropriate.

Provenance

Record: 5630
Objective:
Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Not supplied

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.