Urgent surgical patient classification: Development and validation of a novel instrument using the Delphi approach

The lack of a triage system for urgent surgical patients leads to non-standardized decision-making. Developing an instrument to objectively identify the complexity of care required for each case is challenging. The aim of this report is to develop and validate an urgent surgical patient classification instrument using the Delphi technique.

The study was conducted in several stages: (1) definition of the construct; (2) item elaboration; (3) expert analysis; (4) item selection; (5) pretest. In the first study, scale items were designed and content validity was confirmed. In the second study, the factorial structure was analyzed. In the third study, alternative measurement models were tested. In the fourth study, criterion validity was analyzed.

Experts validated 14 items (31.81%) from Domain 1 with 75% agreement and specific items from Domain 2 with 100% agreement. Factor analysis indicated a two-factor solution explaining 58.4% of the variance. The bifactor model presented the best fit (χ2/df = 1.51; CFI = 0.95; TLI = 0.94; RMSEA = 0.051; SRMR = 0.043). Factors showed excellent internal consistency (α > 0.88; CR > 0.90; ω > 0.92).

This pioneering study developed and validated the content of the first specific instrument for classifying urgent surgical patients regarding their priority for care. The instrument was deemed valid in terms of content, based on expert consensus. Further studies are recommended to evaluate its practical application and perform additional psychometric measures. This instrument has the potential to enhance the organization of emergency services and operating theaters, promoting patient safety and efficient resource management in healthcare institutions. Its implementation should align with current health guidelines and policies to optimize the triage and prioritization process for urgent surgical patients.