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

Abstract

Theatre use is heavily influenced by the presentation and scheduling of emergency cases for unplanned surgery. This research guided the development of a triage standard for scheduling emergency surgery in New South Wales public hospitals and aimed to contribute to a better understanding of decisionmaking practices. An emergency-surgery survey asked questions about urgency of a set of clinical conditions and appropriate time frames for patients to receive surgical treatment for these conditions. Surveys were distributed via 71 NSW public hospitals. A total of 198 decision makers responded: surgeons (42.8%), anaesthetists (24.7%), and nurses (32.5%). Principal component analysis was applied to reduce the data to three urgency classifications, and analysis of variance was used to assess variance of opinions between professional groups. The data suggested that the parameters that distinguish the codes (1, very urgent; 2, semi-urgent; 3, least urgent) were not unequivocally apparent. Although there was a consistent approach to the ?urgency 1? and ?urgency 3? categories, there were significant differences between responses when determining ?urgency 2?. The data indicated that when making decisions, anaesthetists act as intermediaries between surgeons and nurses. There was significant disparity between individuals when respondents were asked to state an ideal time for the commencement of surgery and the maximum length of time that the surgery could wait. This presented a need for a risk assessment tool to be incorporated when developing a dynamic prototype triage instrument.