Irish Journal of Medical Science (1971 -)

, Volume 186, Issue 1, pp 219–224 | Cite as

Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice

  • R. M. HeaneyEmail author
  • I. Reynolds
  • R. S. Ryan
  • I. Khan
  • W. Khan
  • R. Waldron
  • K. Barry
Original Article



Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary.


In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services.


An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention.


1466 patients were admitted as emergencies during the study period. 58 % (850) were male and median age was 48 years (0-100). Average length of stay was 5 days (range 1–125). 327 patients (22.3 %) required operative intervention. The most commonly performed procedure was appendicectomy (52.5 %). 48 (3.3 %) patients were transferred to other hospitals. 131 (8.9 %) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound.


Almost 80 % of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.


Non-operative Emergency Admissions Practice implications 


Compliance with ethical standards

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    HSE Annual Report and Financial Statements 2014. Accessed 22 Dec 2015
  2. 2.
    Ryan M, Kelliher G, Mealy K et al (2015) Characteristics of patients who are acutely admitted to hospital under surgical care and do not have a surgical procedure–is there an alternative to admission? Surgeon. doi: 10.1016/j.surge.2015.07.004 [Epub ahead of print] PubMedGoogle Scholar
  3. 3.
    Model of care for acute surgery. National Clinical Programme in Surgery. Accessed 22 Dec 2015
  4. 4.
    Rosen MP, Sands DZ, Longmaid HE et al (2000) Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. AJR 174(5):1391–1396CrossRefPubMedGoogle Scholar
  5. 5.
    Abujudeh HH, Kaewlai R, McMahon PM et al (2011) Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR. 196(2):238–243CrossRefPubMedGoogle Scholar
  6. 6.
    Datta ST, Davies SJ (2014) Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive. BMC Med Educ 14(Suppl 1):S12CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Garvin JT, McLaughlin R, Kerin MJ (2008) A pilot project of European Working Time Directive compliant rosters in a university teaching hospital. Surgeon 6(2):88–93CrossRefPubMedGoogle Scholar
  8. 8.
  9. 9.
    Healy DA, McCartan DP, Grace PA et al (2014) The impact of regional reconfiguration on the management of appendicitis. Ir J Med Sci 183(3):351–355CrossRefPubMedGoogle Scholar
  10. 10.
    Boyle E, McCormack H, O’Rourke A et al (2012) Improving patient care–the first year in a dedicated surgical assessment unit. Ir Med J 105(7):233–236PubMedGoogle Scholar
  11. 11.
    Forrestal B, Hynes T, Clarke-Moloney M et al (2013) Patient satisfaction following emergency admission via a surgical assessment unit and an emergency department. Ir J Med Sci 182(2):261–266CrossRefPubMedGoogle Scholar
  12. 12.
    Mohamed MS, Mufti GR (2005) The surgical assessment unit–effective strategy for improvement of the emergency surgical pathway? J R Soc Med 98(1):14–17CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Roberts MV, Baird W, Kerr P et al (2010) Can an emergency department-based Clinical Decision Unit successfully utilize alternatives to emergency hospitalization? Eur J Emerg Med 17(2):89–96CrossRefPubMedGoogle Scholar
  14. 14.
    Payments by Results Guidance for 2013-14. https:// Accessed on 31 Jan 16Google Scholar
  15. 15.
    McHugh S, Corrigan M, Sheikh A et al (2011) Factors influencing career choice after initial training in surgery. World J Surg 35(3):487–492CrossRefPubMedGoogle Scholar
  16. 16.
    Wachter RM, Bell D (2012) Renaissance of hospital generalists. BMJ 344:e652. doi: 10.1136/bmj.e652 CrossRefPubMedGoogle Scholar
  17. 17.
    Chabok A, Pahlman L, Hjern F et al (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99(4):532–539CrossRefPubMedGoogle Scholar
  18. 18.
    Khan DZ, Kelly ME, O’Reilly J et al (2016) A national evaluation of the management practices of acute diverticulitis. Surgeon. doi: 10.1016/j.surge.2015.12.004 Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2016

Authors and Affiliations

  • R. M. Heaney
    • 1
    Email author
  • I. Reynolds
    • 1
  • R. S. Ryan
    • 2
  • I. Khan
    • 1
  • W. Khan
    • 1
  • R. Waldron
    • 1
  • K. Barry
    • 1
    • 3
  1. 1.Department of SurgeryMayo University HospitalCo. MayoIreland
  2. 2.Department of RadiologyMayo University HospitalCo. MayoIreland
  3. 3.Discipline of SurgeryNational University of Ireland GalwayCo. GalwayIreland

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