Current models of emergency general surgery care delivery in Manitoba, Canada: a cross-sectional survey

BACKGROUND: Emergency general surgery conditions result in disproportionately high rates of morbidity and mortality. Despite this, little is known about the resources available for related care in Canadian hospitals. Our aim was to describe the resources and structures dedicated to emergency general surgery in Manitoba, Canada. METHODOLOGY: We developed a survey to examine institutional capabilities in providing emergency general surgical care. The survey was developed over three iterations using a modified Delphi technique and was then reviewed separately by community surgeons to ensure broad applicability. A cross-sectional survey of representatives at each of the fourteen hospitals reported to offer emergency general surgery care in Manitoba was performed in two iterations between March and December 2023. Findings were examined descriptively and stratified between tertiary, urban, and rural centres. Our aim was to describe the resources and structures in place for providing related care, including the proportion of hospitals with a dedicated emergency general surgery care model. RESULTS: After exclusions and non-responses, we examined the resources and capabilities of nine institutions. Two tertiary, two urban community, and five rural community centres were evaluated. Of these institutions, 4/9 (44.4%) had an emergency general surgery model of care, including one rural centre. There was a large degree of variation in operative resources, specialty services, and physician learners between centre types. Allied health professionals were more consistently available across hospitals. Our survey results identified several pertinent gaps in care, including a lack of shared treatment protocols, transfer agreements, and quality improvement measures, even at large tertiary centres. CONCLUSIONS: This study demonstrates a pressing need for collaboration between centres and involvement in quality improvement amongst practitioners to meet standards of care in emergency general surgery. The results also show that important aspects of emergency general surgical care can be quantified with our survey and will serve as the basis for expanding this to a country-wide study.