• Hannah Dobson, Weranja K B Ranasinghe, Matthew K H Hong, Liliana N Bray, Manivannan Sathveegarajah, Fatima Vally, and Francis J Miller.
• Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
• Aust J Rural Health. 2015 Jun 1; 23 (3): 155-60.

ObjectiveTo examine the timing of operative management and interhospital transfer of emergency general surgical patients in a regional setting.DesignRetrospective cohort study.SettingThe surgical unit at a major rural referral centre for North-Eastern Victoria servicing a population of 90 000.ParticipantsGeneral surgical patients (n = 649) admitted via the emergency department at Northeast Health Wangaratta between January 2011 and March 2013 undergoing operative management (n = 608) or transfer to a tertiary centre (n = 44).Main Outcome MeasuresTiming of operative management, using appendicectomy as a benchmark operation, was measured as time from presentation to decision to operate, time from decision to surgery, percentage after-hours operating and length of stay (LOS). Time to interhospital transfer was calculated and reasons for delay were sought.ResultsTwo hundred forty-six appendicectomies were performed. Median time from decision to operate to theatre was 3 hours (interquartile range (IQR) 2-8), and total LOS was 43 hours (IQR: 28-56). Two hundred seventy-two procedures (43%) were performed out-of-hours, including 48% of appendicectomies. Median time from decision making to transfer was 10.3 hours (IQR: 4.7-25). Transfer was less likely to be delayed in trauma patients when compared with urgent non-trauma patients (5.3 versus 10.6 hours; P = 0.04).ConclusionEven in the absence of a strict four-hour rule program and a dedicated emergency surgical unit, main outcome measures appear to be comparatively efficient. However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non-trauma transfer from rural centres and bed availability in tertiary hospitals.© 2015 National Rural Health Alliance Inc.

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