Acute Care Surgical Unit

The Acute Care Surgical Unit (also known as Acute Surgical Unit or ASU at Liverpool Hospital is a dedicated emergency General Surgery service that was commenced in 2013 to streamline and improve the emergency management of urgently admitted General Surgical patients

This was as a result of the Department of General Surgery at Liverpool Hospital recognising the growing need for a specialised unit for patients admitted with emergency general surgical problems such as acute cholecystitis, pancreatitis, appendicitis, infections requiring surgical drainage, small and large bowel obstructions, strangulated hernias and perforated ulcers. It is globally recognised that a dedicated acute care surgery unit with well trained staff results in better outcomes and safer care.

The unit, which was initially called the Acute Surgical Unit, proved to be a greater success than anticipated, resulting in measurable improvements in several aspects of patient care and hospital efficiencies. For example, in the first year of activity, the ASU facilitated a 25% reduction in after-hours operating, alongside significantly reduced lengths of stay for common emergencies such as patients undergoing emergency cholecystectomy. There was also improved surgical trainee supervision and training.

In mid-2019, the ASU merged with the Trauma Unit to create the Trauma and Acute Care Surgery (TACS) Unit aligning the model of care with internationally recognised specialty models of care. Please see Model of Care. The Acute Care Surgery Unit provides streamlined, Consultant-led decision making and management for emergency general surgical patients. The service has a dedicated ASU weekday roster, which includes an ASU Surgeon in-house, who is responsible for attending all clinically urgent patient reviews, doing clinical rounds, radiology rounds, afternoon handover rounds, and leading any necessary operative interventions. During regular hours, all acutely admitted patients are automatically admitted under the ASU Surgeon on call, and any consultations to general surgery from other medical or surgical units will also be attended to by the ASU, unless a specific “sub-specialty” team has been requested.

After hours and on weekends, new patients are admitted by the “general surgeon on-call” rather than the ASU, and selected patients will be referred to the ASU consultant the next day (or Mondays after a weekend) for surgical management. There is a plan to extend the operations of the TACS unit to 24/7 coverage.

The TACS unit is the busiest unit within the Department of General Surgery at Liverpool Hospital and provides a dedicated team of Consultants, Fellows, Registrars, Junior doctors (interns and residents) and Nurses to attend to the care needs of our severely injured and critically ill general surgical patients.

Patients cared for by the ASU are followed up in our ASU clinic.

The ASU’s development has been exciting and has had an enormous impact on the provision of safe, evidence-based care for our patients as well as surgical trainee education, alongside improvements in hospital efficiencies.


Elective Surgery

Dr Valerie Malka is the Director of the Trauma and Acute Care Surgical Unit at Liverpool Hospital. She was the previous Director of Trauma Services at Westmead Hospital for over a decade. She is an EMST Director and DSTC Instructor with a great passion for trauma and acute care surgery. With special interests in education and quality assurance she has worked extensively in patient safety and the maintenance of ethics in healthcare. Valerie has worked with the International Committee of the Red Cross and the International Rescue Committee and holds a Diploma in International Humanitarian Assistance from Geneva University and a Master’s Degree in International Public Health with a major in Humanitarian Law. She also holds a Master’s degree in Journalism and works freelance writing medical, health and wellbeing articles.