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A trauma team approach to the initial assessment, investigation and treatment of potentially seriously injured patients has been implemented at a district general hospital. Team members are mobilised by an emergency paging system which is activated when a patient fulfils one or more of a predetermined list of historical, pathophysiological and anatomical criteria. Aspects of the function of the trauma team were assessed after 10 months of operation. The problems encountered and solutions implemented are discussed. As a result, the structure and function of the trauma team has been modified and improved. Although hospitals differ in workload and staffing, the trauma team concept is possible and achievable at no extra cost. Trauma teams maximise existing resources and constitute a valid approach to the early management of the irregular presentation of the severely injured patient to district general hospitals. The establishment of such teams with members who should be ATLS trained, should be a current priority in district general hospitals in the UK.

Between January 1978 and December 1987 there were 23,557 surgical admissions to the University Surgical Unit in Southampton. During this period there were 543 deaths, an overall death per admission rate of 2.3%. During the 10-year period the number of admissions per year had risen from 1884 in 1978 (death per admission = 3.6%) to 3467 in 1987 (death per admission rate = 1.7%). At the monthly audit meeting an attempt was made to classify each death as 'avoidable' or 'unavoidable'. During this 10-year period it was considered that there were 89 'avoidable' deaths. This represents an avoidable mortality rate (AMR) of 0.38%. These 'avoidable' deaths were due to a wide variety of causes and this paper discusses the lessons learnt from a review of surgical mortality and outlines how units might compare results.

32 Wessex surgeons took part in a survey of preoperative antimicrobial prescribing practice for elective colorectal surgery. Only 1 surgeon did not prescribe antimicrobials. 15 (48%) of those surgeons giving antimicrobials used systemic antibiotics only, whilst 9 (29%) gave agents both systemically and orally. With 1 exception, all surgeons used an agent effective against anaerobes, whereas 27 (87%) used an agent or agents to cover both groups. All the surgeons started the antimicrobials before surgery, and half continued them for less than 48 h. Conventional bowel preparation was found to be the most popular method.

Over a 10-year period, 47 infants with congenital hypertrophic stenosis underwent Ramstedt's pyloromyotomy in a district general hospital. The operations were carried out by 10 surgeons-6 consultants and 4 registrars. There were 3 major wound infections and 3 incisional hernias. One infant was referred to a specialist centre for reoperation.