Surveying prioritisation for emergency surgery - do the specialties involved agree?

Surgical resources are often shared across medical specialties, which can lead to conflicts over prioritisation during on-call hours. This study investigated factors contributing to inter-speciality conflict in the prioritisation of emergency surgical cases.

A survey on views of surgical urgency and prioritisation of 22 hypothetical cases was distributed to Swedish physicians involved in emergency surgery via posters in operating departments and administrative areas, and by email. The Kruskal-Wallis test and Dunn's post-hoc test were used to compare responses across specialties. Factors associated with daily conflicts were identified using logistic regression.

Of 233 respondents, 201 (90%) reported sharing resources with other specialties. General surgeons (45%), orthopaedic surgeons (15%), and anaesthetists (15%) were the most represented. Over half reported insufficient resources for emergency surgery. Sixty-nine per cent perceived that other specialties over-prioritised their own patients. Thirty-nine respondents (17%) experienced daily conflicts over case prioritisation. Minor differences were observed in how respondents perceived their own prioritisation, that of other specialties, and the prioritisation of hypothetical cases. Daily conflicts were associated with concerns about compromised patient safety (odds ratio [OR] 8.05 and 95% confidence interval [CI] 1.6-63.5 for agreeing vs. strongly disagreeing/disagreeing), whereas greater perceived resource availability was associated with fewer conflicts (OR 0.68, 95% CI 0.48-0.96).

Perceived threats to patient safety and resource scarcity were associated with daily prioritisation conflicts. Although respondents frequently suspected over-prioritisation by other specialties, observed differences in prioritisation between the responsible specialty and others were small. Further research on shared prioritisation protocols and resource allocation, including international comparisons across health-care systems and cultures, is warranted.