Emergency physicians and surgeons join hands for better collaboration

Over the past 15 years, emergency physicians have begun to establish themselves more and more in Swedish emergency departments. In some hospitals, development has come a long way, others are at an early stage or lack emergency physicians altogether. And in some hospitals, the emergency physician’s efforts have failed.

The arrival of the emergency doctors was not without pain. This creates territorial disputes and other conflicts with other medical specialties in the emergency department. An example of this is surgeons.

In order to make the transition to emergency departments led by emergency physicians less stressful, the Swedish Surgical Society, SKF, and the Swedish Society for Emergency Medicine, Swesem, have started a collaboration.

– We called the surgeons because we noticed conflicts in different places. At the same time, there are many places where collaboration works very well, says Michael von Schekefuss, Swesem’s president and emergency physician and medical director at the emergency department in Norrköping.

Surgeons gnawed.

“We saw a common interest,” says Association of Surgeons President Linus Axelsson, a colorectal surgeon in Blakinge.

The central and urgent issue for surgeons is that the volume of surgery and training for ST doctors is decreasing. Today, the number of operating surgeons is greater than demand, with the exception of some surgical fields. ST doctors are assigned to surgery to fill emergency lines rather than to operate.

A few years ago, the specialty association wrote in the ST Physicians’ Training in Surgery book that on-call workload should not exceed 30 percent of work time. Recently, they also made an update that at least 50 percent of the time should consist of planned clinical duty with practical training.

– We had to because ST doctors were spending more time in the emergency department, says Helena Rosen, a vascular surgeon and surgeon at Växjö and representative director of studies on the Education Committee at SKF.

You see many of the elements of value creation in collaboration from the perspective of the Director of Studies and Education.

In order to raise surgical quality, ST doctors’ mission must be refined, according to the Union of Surgeons. And there emergency doctors can be a solution. In Swedish emergency departments where ER doctors have established themselves properly, ST doctors in surgery are very experienced in surgery.

– We see a trend that the greater the bulk of emergency operations that are borne by emergency physicians, the more satisfied the surgeons are with their operating time and emergency operations. However, both surgeons and emergency physicians believe that surgeons’ involvement in emergency care is still important, says Matthias Jørge, an emergency physician at Sundsvall Hospital and secretary at Susem.

Over the past year, the societies have conducted a joint survey to get a better understanding of how collaboration among medical groups works, and have held joint group discussions at Surgeon’s Week and the SWEET Emergency Medical Conference.

– This is an attractive issue and a change that affects a lot. There were an incredible number of people who had opinions, both surgeons and emergency physicians. Linus Axelsson says that ER doctors and ST doctors in surgery don’t have the same background and have different perspectives on how things should work. He adds:

– If you have an emergency line manned by an ER doctor during the day and an ST surgeon at night, you must adapt the operation for it to work. Otherwise, there will be conflicts.

Now the associations are considering producing a ‘wise book’ with advice on how to make the delivery of emergency physicians as successful as possible based on the lessons learned so far.

– Although of course you have to adapt it locally, we notice that some things seem to come back, says Linus Axelsson.

What is your advice to those who are planning or planning to build an emergency medical clinic?

– Keep in mind that an emergency physician is not an emergency room physician but is a specialty of its own. We surgeons must see who the emergency physicians are and what their mission is. And be prepared to compromise – many times. It is unavoidable, says Linus Axelsson and continues:

– When you develop, for example, memos and guidance documents, they must be collaborative documents. Especially when it’s a mixed emergency line with an emergency doctor during the day and a surgeon at night. Then you have to think about it so it works around the clock, says Linus Axelsson.

Two years ago, Swesem developed a guideline for the interface between the emergency clinic and inpatient care – a model for what inpatient care should take over, when it should happen, who should take over and how the delivery should take place.

– But I think it is very important to stress that there must be room for local solutions. You have to take into account local conditions and traditions and create a collaboration that works well exactly where you are, says Michael von Schekfuss.

Also from an educational perspective, it is extremely important to have a common goal picture and exercises so that you know what you are aiming for, says Helena Rosen.

The intention is not for surgeons to leave the emergency department. They must still be able to handle the emergency surgery patient, but this must be done in collaboration with the emergency physicians.

What are the biggest challenges?

Lack of care homes. I think we can get emergency physicians and surgeons to work together, but I think what can lead to accidents is a lack of places to care, says Linus Axelsson.

In his opinion, most of the disagreements arise because of this.

And according to Swesem, another pitfall is ER doctors presenting for the wrong reason. For example, because of the political hope of solving emergency room problems by magic.

For emergency physician initiatives to be successful, funds must be added, there must be stabilization of managers on the clinic floor and there must be a long-term goal. And a will to change radically, as Michael von Schefuss points out.

– You have to aim for emergency physicians to eventually take over the traditional lines in the emergency department. Intermediate solutions do not create any added value, neither for patients nor for the hospital. I think awareness is still lacking in many hospitals.

Both Swesem and SKF see the long term as crucial.

– There will be some friction at first – and that’s normal because we’re three or four different disciplines that have to come together. There will be a start-up phase of a few years where everything is fine from the start, says emergency physician Matthias Jörg.

What do you hope will have happened in ten years?

– We need to become more numerous and own our procedures and define what emergency medical care is. We must not only endure the system that has proven its effectiveness, but we must create a new system with our own flows. Unfortunately, it will likely take time, says Michael von Scheefuss.

SKF’s hope, in turn, is that ST doctors in surgery have a more delicate task.

– I hope we will get the right skills when we invest in STs in different specializations, rather than just putting more people in the system, says Linus Axelsson.

According to him, most surgeons—especially younger ones—believe that emergency physicians perform an important job. Going forward, he believes more and more people will be convinced.

Health care is becoming more specialized. And we have to meet that with the specialists who can help the specialists make the right decision for the patient. We must act on the right patients.

Read more:
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