LAUSR

nurses, anaesthetist and a surgeon or additional surgical registrar. All of this, for the sake of zero to two or at best three emergency cases per day. This is not cost effective. The alternative involves the opening of an additional theatre, but additional staff are only used on demand. The difficulty is in finding an extra three nurses willing to be sitting at home unpaid, waiting to be called on short notice. It also involves convincing a general practitioner anaesthetist to be ready on short notice to abandon many patients waiting for him in his clinic. Option 3 is to squeeze the after-hour emergency cases onto the next day’s elective list. This has ended on many occasions with either the cancellation of one or more elective cases. In the event that cancelling was not done or was not acceptable, then the elective list was pushed back beyond working hours. In a few instances, the emergency patient from the night before was still waiting to be operated upon in afterhours, but on the next day. This will not only bring little or no benefit to the hospital, but will also mean a delay in the patient care, and unnecessary occupation of a hospital bed for additional day. A recent article in British Journal of Surgery highlighted the fact that improvement in mortality and morbidity in the out-of-hours services over the last 5 years was attributed mainly to the increased consultant input, with more consultant delivery of intensive care, anaesthesia and radiology service, and is not simply a matter of whether we operate at working hours or afterhours.