I Need Emergency Surgery—What Do I Do?

Caroline E. Reinke, MD, FACS, is an emergency general surgeon at Atrium Health in Charlotte, NC, and on the American College of Surgeons Emergency General Surgery Advisory Committee. As one of the leaders who created the Emergency General Surgery Verification Program, Dr. Reinke offers patients and care teams guidance in how to improve the treatment experience when patients face the unexpected, and often urgent, need for emergency general surgery.

It’s just after midnight, and the emergency room physician tells you a surgeon will be coming to evaluate you soon. For most people—particularly those not in the medical field—having unplanned surgery is a major life disruptor. Yet, emergency general surgery accounts for roughly 4 million patients admitted to the hospital and represents 11% of all surgical procedures every year. Most commonly, these conditions include hernias, ulcers, gallbladder inflammation, appendicitis, or bowel obstructions. There is also a large number of patients with these serious conditions that often can be treated as outpatients or observed but not admitted to a hospital.

As a surgeon whose passion is caring for emergency general surgery patients with these conditions, my colleagues and I understand that these situations can be intimidating and confusing, especially because these conditions need to be treated quickly. The goal of the care team is to do everything we can to achieve the best possible outcome for our patients. I know that when physicians and patients work together and have good communication, we improve the chances for better outcomes.

Communication Is Key

First, most emergency general surgery patients are experiencing both information overload and significant pain, which can make it challenging to feel confident in navigating the situation and advocating for themselves. Even in a hospital that has all the necessary resources to provide excellent surgical care, there is value in working alongside your surgical care team. Their goal is to make certain you are getting the best, most complete information by adequately communicating your symptoms. 

There are a few things patients can do to improve their experience and, hopefully, reduce some of their stress. First and foremost, have an advocate with you if possible. This can be a family member, a friend, or anyone you trust to be part of your healthcare journey. The advocate can serve many important roles including:

• Helping you to keep a list of questions for your care team
• Taking notes about the care plan
• Communicating with others in your support group on your behalf.

It is helpful to take notes—whether with pen and paper or on an electronic device. The surgical team will have many topics to discuss with you and may include treatment options (operative versus non-operative), things to do today to prepare for surgery, and discussion about anticipated recovery—and how much of this is delivered at one time may be impacted by the length of your hospital stay. Information overload is common—we see it every day—so having a second set of ears and notes can be incredibly helpful.

Communication in all directions is critical to successful care. The surgical team will provide information about the plan of care and surgical treatment and ask you for information about your symptoms and daily events. This exchange often happens during morning rounds, which in addition to occurring very early in the morning, can also be somewhat brief. Other opportunities for education can be valuable, starting with talking to the nursing team, who typically are very familiar with care plans based on the disease or illness. If you or your advocate have additional questions, you can request that someone from the surgical team come back later in the day for additional discussion. It is helpful to know that the ultimate pathway of care often has many branching points. While the surgical team can walk you through the next 1-2 likely steps, it’s not always feasible to discuss all the possible outcomes. Due to the complexities of the situation, taking it one step at a time is often necessary and avoids creating anxiety for patients about outcomes that they, ultimately, will not likely encounter.

Leverage the Entire Team

Many times, patient questions are about the process of anesthesia for surgery. Commonly, patients will meet their anesthesia team in preoperative holding, and again writing down questions to have for the discussion can be helpful. If time permits and the hospital has the resources, you or your advocate can request to talk to the anesthesia team the day before the surgery. Surgeons rely on our colleagues in anesthesia to provide the best information to patients about how this process may impact them. 

Finally, communicating about your symptoms and experience is important. Pain is a common symptom that can help the surgical team determine the best treatment option. Patients should always feel empowered to communicate pain levels to their care teams, both during rounds and with nursing staff throughout the day. You are the only one who fully knows and understands your body, and the clinical care team has the experience to help determine if your experience is part of normal recovery. There’s never a wrong time to voice discomfort. If your disease process involves the gastrointestinal tract, your surgical team will likely ask daily if you have passed gas or had a bowel movement. Mobility—walking in the hallways—is an important part of recovery. Walking can be uncomfortable and takes a lot of effort, but it is a critical part of recovery. 

The American College of Surgeons developed standards as part of its Emergency General Surgery Verification Program to help hospitals deliver the best possible care to patients experiencing these urgent surgical conditions. Our goal is to help hospitals identify the resources necessary to best address patient needs. These clinical practice guidelines guide hospitals in how to expertly manage this type of care. Patients should look for an ACS-verified hospital so that they will receive the highest quality of care, and that the hospital team will be prepared to solve any number of problems. Ultimately, we all want them to return to their normal lives as quickly as possible and if care teams work hand in hand with their patients, we can achieve this goal. 

About the Author

Caroline E. Reinke, MD, FACS, is an emergency general surgeon at Atrium Health in Charlotte, NC, and on the American College of Surgeons Emergency General Surgery Advisory Committee.