New guidelines for safe surgery have been drawn up by the HSE and the Royal College of Surgeons in Ireland (RCSI).

The guidelines warn against inexperienced junior doctors being heavily involved in the assessment of whether patients need acute (urgent or emergency) surgery, as they say this can lead to unnecessary admissions or can fail to identify critically ill patients needing urgent treatment.

According to the HSE and RCSI, the Model of Care for Acute Surgery sets out the principles and strategies necessary to ensure the provision of high-quality acute care for surgical patients in Ireland.

The guidelines state that the efficient delivery of acute surgery requires that it be functionally separate as possible from elective (non-emergency or planned) surgery and that it should not be diminished as a priority against elective surgery.

The model of care stresses that acute surgery should be consultant-delivered, and hospitals treating acute surgery patients should be organised within designated groups or networks, as is currently being planned by Health Minister James Reilly.

Providing consultant-delivered care will need an assessment of the consultant numbers required to deliver acute and elective care when it is recognised that there is a shortage in most surgical specialties in Ireland relative to European and International norms, the report states.

It says this will also require a re-examination of the overall career structure for consultants. While recognising that change can only be gradual, particularly in the current environment.

"Nevertheless, not moving in this direction for purely financial reasons would likely represent a significant missed opportunity to the improvement of quality of care."

The report says the early assessment of patients likely to need acute surgery should be undertaken as early in their surgical pathway as possible by a senior clinician with the appropriate skills and competencies to recognise when surgery may or may not be required.

"Studies have shown that the early intervention by senior decision makers early in the patient's pathway improves outcomes for patients with fewer inappropriate admissions, earlier definitive surgical treatment and discharge and makes for a more efficient use of resources."

The guidelines say this is particularly important where junior doctors in training are insufficiently experienced to question the need for patient admission, perform diagnostic tests that are inappropriate or may fail to identify critically ill patients early in their clinical course.

They say consultant work patterns in acute surgery should aim to be exclusive of other activities when they are providing acute surgical care.

They say allocating operating theatres should be matched to the emergency surgery workload and managed by good theatre governance as well as dedicated anaesthesia and surgical leadership.