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Surgical decision making

C V Ruckley, J B Ferguson, C Cuthbertson

    The British Journal of Surgery
    |December 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Surgical patient selection for care level and length of stay predictions are reliable. This allows for confident patient advice and efficient use of hospital resources in general surgery outpatient clinics.

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    Area of Science:

    • General Surgery
    • Health Services Research

    Background:

    • Accurate patient assessment and resource allocation are crucial in surgical outpatient clinics.
    • Understanding factors influencing surgical decision-making and length of stay forecasts is essential for optimizing patient care pathways.

    Purpose of the Study:

    • To evaluate the reliability of decision-making processes for selecting patient care levels in a general surgical outpatient setting.
    • To assess the accuracy of surgeons' forecasts for postoperative length of stay.
    • To determine the impact of these decisions on patient outcomes and resource utilization.

    Main Methods:

    • Prospective study of 2000 new referrals to a general surgical outpatient clinic.
    • Surgeons recorded reasons for selecting care levels (main ward, 5-day ward, day bed, minor outpatient surgery).

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  • Patient progress and outcomes were monitored; postoperative stay forecasts were compared with actual durations.

    • Main Results:

    • 88% of patient selections were based on medical factors; 12% were influenced by social/psychological factors.
    • 84% of patients experienced care as planned; 1.75% required transfer to a higher care level, and 1.4% were re-admitted.
    • Postoperative stay forecasts were accurate for hernias and varicose veins but underestimated for major surgery.

    Conclusions:

    • The selection of care level and forecast of postoperative stay in general surgery are sufficiently reliable.
    • These reliable predictions enable confident patient advice and efficient resource management.
    • The study supports the effectiveness of current decision-making protocols in surgical outpatient care.