Re: Wysocki AP. The ASU – Are surgeons now unaccountable? (ANZ J. Surg. 2010; 80: 944)
The surgeons at Nepean Hospital appreciate the concerns expressed by Dr Wysocki (ANZ J Surg, 2010, 944). There is no need to “ensure compliance”. Compliance occurs because of appropriate and correct professional behaviour. The ASU functions the same way every day of the year. Limited space does not permit me to correct misconceptions and address other minor concerns.
Dr Wysocki’s chief concern is the loss of surgeon accountability. In the traditional system the patient was managed by a registrar-lead service with the surgeon “available”. The ASU is a consultant-lead service. All admissions are seen and assessed by a consultant on the day of admission; all surgery is supervised by the surgeon. Each patient stays in the ASU and is reviewed by the ASU consultant each day. This acts as an audit process on each surgeon’s performance. This is a higher level of consultant responsibility and involvement than in most public hospitals in Australia. We presume from Dr Wysocki’s concern that he sees each of his patients every day, including weekends and public holidays. Unfortunately this outstanding performance is not the norm.
The responsibility and accountability for the acute surgical patient is not being removed. It is increased by more direct consultant involvement on a daily basis, including weekends and public holidays. The consultant is accountable and responsible on their day and hands this responsibility and accountability on to the next surgeon. This requires a high level of commitment, trust and team work. We are teaching our registrars some important components of the nine competencies of the RACS; in particular collaboration, communication, team work and health advocacy.
We appreciate his comments and offer him, his colleagues, any interested clinician or administrator an open invitation to come and visit the Nepean ASU.
Michael Cox, Sulman Ahmed, John Cartmill, Deborah Cheung, Patrick Cregan, Jodie Ellis-Clark, Fadil Khaleal, Han Liem, Huong Nguyen, Mark Richardson, Tony Shakeshaft, David Youkhanis - Consultant Surgeons; Linley Cook, Jennifer Dobson - Nurse Practitioners
ASU, Nepean Hospital
