Out‐of‐hours operating — failure to close the audit cycle

A prospective study of all out‐of‐hours operations performed in a district general hospital was undertaken over two periods. During the first period (1 month) facilities for emergency operating were reviewed and it was concluded that out‐of‐hours operating should be reduced and several tactics to improve the situation were agreed. A re‐audit was undertaken over 4 months (second period) and results of the two periods compared. Orthopaedic cases performed out‐of‐hours in both periods of study were 38% vs 40%. Mean theatre delay for general surgical cases in both periods was 5 h 30 min vs 5 h 21 min and theatre usage after midnight during weekdays showed no significant difference (23% vs 28%). 50% of operations performed after midnight in both periods could possibly have been avoided. The attempt to reduce out‐of‐hours operating failed because there was no protocol. In order to reduce inappropriate operating after midnight, a dedicated daytime emergency theatre is necessary in addition to an increase in the number of daytime orthopaedic trauma lists. Failure to close the audit cycle loop suggests that a more determined effort is required to reduce unsupervised emergency surgery and unnecessary sleep deprivation.