Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?

Abstract

Objective. This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list.Methods. A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants.Results. There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres.Conclusions. Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations.What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon's demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital. What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources. What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.

Prioritising patients for semi‐urgent surgery: A scoping review

“…In their observational studies, Lin et al (2022) and Blanch et al (2016) found that there was little guidance or evidence for how to prioritise patients who have the same triage ranking. This scoping review supports the need for clear guidelines that should be implemented into hosptial policy and emphasises the importance of understanding factors influencing clinical prioritisation in scheduling semi-urgent surgeries (Ax et al, 2019;Bhattacharyya et al, 2006;Fitzgerald et al, 2006;Fitzgerald & Wu, 2017;Leppäniemi & Jousela, 2014). The lack of consensus and guidance in clinical prioritisation for semi-urgent surgeries poses a significant risk to patients, surgical teams and departments.…”

“…Studies were conducted in several countries (Figure 2) with most undertaken in Europe ( n = 9) (Ax et al., 2019; Cardoen et al., 2010; Fitzgerald & Wu, 2017; Koivukangas et al., 2020; Leppäniemi & Jousela, 2014; Sandbaek et al., 2014; van Veen‐Berkx et al., 2016; Wullink et al., 2007; Zonderland et al., 2010). Across the 12 research articles, study characteristics are reported in Table 3.…”

“…Only three scheduling approaches were identified in the included studies. Most articles described the different scheduling approaches related to operating room utilisation ( n = 7) (Cardoen et al., 2010; Fitzgerald et al., 2006; Fitzgerald & Wu, 2017; Sandbaek et al., 2014; van Veen‐Berkx et al., 2016; Wullink et al., 2007; Zonderland et al., 2010). The remaining articles focussed primarily on how different scheduling approaches increased utilisation of operating room time and decreased out‐of‐hours procedures by using a dedicated emergency operating room approach ( n = 5) (Ax et al., 2019; Bhattacharyya et al., 2006; Cosgrove et al., 2008; Koivukangas et al., 2020; Leppäniemi & Jousela, 2014).…”

“…Five articles included a multidisciplinary team comprising a surgeon, anaesthetist and nurse in the clinical priority process of scheduling surgery (Bhattacharyya et al, 2006;Cardoen et al, 2010;Cosgrove et al, 2008;Fitzgerald et al, 2006;Fitzgerald & Wu, 2017).…”

“…studies. Most articles described the different scheduling approaches related to operating room utilisation (n = 7)(Cardoen et al, 2010;Fitzgerald et al, 2006;Fitzgerald & Wu, 2017;Sandbaek et al, 2014;van Veen-Berkx et al, 2016;Wullink et al, 2007;Zonderland et al, 2010). The remaining articles focussed primarily on how different scheduling approaches increased utilisation of operating F I G U R E 1 Scoping review PRISMA.…”