Surgeon Perspectives on Responsibility for Acute Lower Gastrointestinal Surgical Conditions: A Modified Delphi Study

Area of Science:

• Surgical Specialties
• Gastrointestinal Surgery
• Healthcare Management

Background:

• Inconsistent allocation of acute lower gastrointestinal surgical conditions between acute care surgeons and colorectal surgeons.
• Lack of consensus guidelines for service assignment in teaching hospitals with shared call.

Purpose of the Study:

• To establish consensus on the allocation of acute lower gastrointestinal surgical conditions between surgical specialties.
• To develop a framework for guiding service assignment in teaching hospitals.

Main Methods:

• A two-round modified Delphi study involving expert surgeons.
• Utilized a 70% consensus threshold and directed content analysis for qualitative data.

Main Results:

• Consensus was reached for only 50% of conditions after round 1.
• Round 2 revealed no uniform specialty assignment, highlighting determinants like practice models, specialty training, and patient clinical status.
• Hemodynamic instability prioritized surgeon availability over specialty expertise.

Conclusions:

• Service allocation for acute lower gastrointestinal conditions is context-dependent, influenced by clinical factors, surgeon expertise, and available resources.
• A Delphi-derived framework can structure triage and care pathways in systems with dual surgical coverage.