title: Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates.
abstract: National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p < 0.01). We conclude that auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.
authors.affiliation: Anaesthesia and Critical Care, Newcastle upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. joe.cosgrove@nuth.nhs.uk
authors.forename: J F
authors.initials: JF
authors.lastname: Cosgrove
authors.forename: M
authors.initials: M
authors.lastname: Gaughan
authors.forename: C P
authors.initials: CP
authors.lastname: Snowden
authors.forename: T
authors.initials: T
authors.lastname: Lees
mesh_terms: D003142:Communication; D004630:Emergencies; D004739:England; D013502:General Surgery / Q000458:organization & administration* / Q000592:standards; D006302:Health Services Research / Q000379:methods; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008485:Medical Audit; D009873:Operating Rooms / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000592:standards; D013503:Surgery Department, Hospital / Q000458:organization & administration; D013997:Time Factors; D014850:Waiting Lists