Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists

Area of Science:

• Health Services Research
• Surgical Management
• Clinical Decision-Making

Background:

• Operating theatre use is significantly impacted by emergency surgery scheduling.
• Developing effective triage standards is crucial for optimizing surgical resource allocation.
• Understanding decision-making processes in emergency surgery is vital for improving patient care.

Purpose of the Study:

• To guide the development of a triage standard for emergency surgery scheduling in New South Wales public hospitals.
• To enhance understanding of decision-making practices among surgical teams.
• To identify variations in urgency classification and timing for emergency surgical procedures.

Main Methods:

• An emergency-surgery survey was distributed to 71 New South Wales public hospitals.
• 198 decision-makers (surgeons, anaesthetists, nurses) responded to questions on clinical condition urgency and treatment timeframes.
• Principal component analysis and analysis of variance were used to analyze urgency classifications and inter-professional opinions.

Main Results:

• Urgency classifications (very urgent, semi-urgent, least urgent) were not always clearly distinguished.
• Consistent agreement was found for 'very urgent' and 'least urgent' categories, but significant differences emerged for 'semi-urgent' cases.
• Anaesthetists acted as intermediaries between surgeons and nurses, with considerable individual disparity in ideal and maximum surgical commencement times.

Conclusions:

• The study identified significant variability in the perception of urgency for semi-urgent surgical cases.
• Anaesthetists play a key role in mediating decisions between surgeons and nurses.
• A risk assessment tool is needed for a dynamic prototype triage instrument to improve emergency surgery scheduling.