Emergency cross-cover of surgical specialties: consensus recommendations by the Association of Surgeons in Training

Abstract

In recent years, working time restrictions and a restructuring of postgraduate surgical training have resulted in increased reliance on emergency cross-cover (ECC)--the provision of emergency care by a doctor trained or training in a different specialty to that which they are requested to assess or manage. There are increasing concerns surrounding the provision of ECC, particularly regarding appropriate supervision of trainees and in turn their competence, experience and confidence in dealing with surgical problems of outside their own specialty. Surgical training has failed to keep pace with workforce changes and in this document we outline the key principles of providing safe ECC. In particular this includes the medico-legal implications of providing such cover outside a surgical trainee's normal area of practice, particularly without previous experience or means for regular skills practice and up-dating. We report the findings of an ASiT snapshot survey that demonstrates concerns surrounding existing cross-cover arrangements. Variable access to senior support, together with varied willingness to provide this, and a paucity of specific training opportunities for trainees required to provide cross-cover were highlighted. These have the potential to promote variability in patient care and resource use by those providing care outside of their usual specialty. This document provides consensus recommendations to address these issues, including clarification of curricula and improved provision of training for, and supervision of, trainees who are expected to deliver cross-cover.

Keywords: Cross-cover; Emergency; Patient safety; Service provision; Surgical training.