Key Learning Points

• Understand the problem of emergency perioperative provision in NHS trusts

• Consider the material and human resources required to deliver efficient emergency perioperative care

• Outline the political and professional drivers of change in emergency surgical services

• Understand the impact of unexpected events such as major civilian incidents on the rest of the surgical service

Introduction

The management and organization of the emergency operating list is not a static process but a constant process of assessment and priority management. This chapter aims to provide some insight into the organization, management and leadership of such a surgical list.

Prior to the introduction into the NHS of dedicated emergency operating rooms, urgent surgical procedures were commonly left until the end of elective lists. Most of these operations were usually performed by junior grade surgeons without the supervision of an experienced consultant, with the majority of cases being performed out of hours (Wyatt et al. 1990). The Report of a Confidential Enquiry into Perioperative Deaths (CEPOD; Buck et al. 1987) clearly demonstrated the need for increased supervision of junior surgeons. In response to the publication of this paper, many NHS Trusts went on to provide dedicated emergency surgical operating rooms.