[Emergencies and continuous care: overload of the current on-call system and search for new models]

Abstract

Emergency surgical care is still provided by means of an 24 hours physical presence "on-call" model (encompassing a normal day followed by "on call"), and is obligatory for all staff. This defective organisation of work has become unsustainable with the acceptance of the European 48 hours Directive, and is gruelling due to the excessive night work and feeling of being locked in that it entails. Emergency general and digestive system surgery care cannot be provided by a single organisational model, but has to be adapted to local circumstances. It is important to separate scheduled activity from urgent, and whereas increasingly more resources are dedicated to scheduled care, sufficient resources are also required for urgent activities, that cannot be considered as simply an "on call" or a fleeting stop in scheduled activity. Core subjects in residency, creating different levels of provision and activities, the analysis of urgent activity per work period and the identification of foreseeable activity, to maintain a pro-active mentality, and the disappearance of the "overtime" concept, should help provide another care model and method of remuneration.