Dedicated operating room for emergency surgery improves access and efficiency

Abstract

Background: Scheduling emergency cases among elective surgeries often results in prolonged waits for emergency surgery and delays or cancellation of elective cases. We evaluated the benefits of a dedicated operating room (OR) for emergency procedures available to all surgical services at a large children's hospital. Methods:We compared a 6-month period (January 2009 to June 2009) preimplementation with a 6-month period (January 2010 to June 2010) postimplementation of a dedicated OR. We evaluated OR use, wait times, percentage of cases done within and outside of access targets, off-hours surgery, cancellations, overruns and length of stay.Results: Preimplementation, 1069 of the 5500 surgeries performed were emergency cases. Postimplementation, 1084 of the 5358 surgeries performed were emergency cases. Overall use of the dedicated OR was 53% (standard deviation 25%) postimplementation. Excluding outliers, the average wait time for priority 3 emergency patients decreased from 11 hours 8 minutes to 10 hours 5 minutes (p = 0.004). An increased proportion of priority 3 patients, from 52% to 58%, received surgery within 12 hours (p = 0.020). There was a 9% decrease in the proportion of priority 3 cases completed during the evening and night (p < 0.001). The elective surgical schedule benefited from the dedicated OR, with a significant decrease in cancellations (1.5% v. 0.7%, p < 0.001) and an accumulated decrease of 5211 minutes in overrun minutes in elect ive rooms. The average hospital stay after emergency surgery decreased from 16.0 days to 14.7 days (p = 0.12) following implementation of the dedicated OR. Conclusion:A dedicated OR for emergency cases improved quality of care by decreasing cancellations and overruns in elective rooms and increasing the proportion of priority 3 patients who accessed care within the targeted time.Contexte : Ajouter des chirurgies urgentes à l'horaire des chirurgies non urgentes prolonge souvent l'attente pour les premières et entraîne des retards ou des annulations pour les secondes. Nous avons évalué les avantages d'un bloc opératoire dédié aux urgences et accessible à toutes les spécialités chirurgicales dans un grand hôpital pédiatrique.Méthodes : Nous avons comparé 2 périodes de 6 mois chacune, soit avant la création du bloc opératoire dédié (de janvier 2009 à juin 2009) et après sa création (de janvier 2010 à juin 2010). Nous avons évalué l'utilisation du bloc opératoire, les temps d'attente, le pourcentage de cas réglés à l'intérieur et à l'extérieur des temps cibles, les chirurgies effectuées en dehors des heures normales, les annulations, les dépassements du temps prévu et la durée des séjours hospitaliers.

Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study

“…In hip fracture surgery, delay is associated with morbidity and mortality, 6,7 but for other surgeries, the effect of delay on outcomes is unclear. [8][9][10][11][12][13] Because it is very expensive to expand or reorganize operating room resources to improve access, [14][15][16] understanding the relation between delay and outcomes for all types of emergency surgery is needed.…”

Trade-offs in operating room planning for electives and emergencies: A review

“…Similarly, Heng and Wright [34] argue that only 9% of the patients are of the highest urgency category (i.e., requiring surgery within one hour) while 63% can get surgery within twelve hours.…”

“…In general, non-elective patients get priority over the patients in the elective schedule and often it is the attending staff surgeon who decides on the exact order. Although several authors ( [9,34,70,96]) explicitly mention that the non-electives are served according to the applied classification system (i.e., there is a fixed priority between the different categories), most papers do not mention the prioritization system. Table 7 also shows that first-come, first-served (FCFS) is assumed in several models and simulations, even though the survey of Cardoen et al [14] reports that about 68% of the respondents indicate that the arrival sequence is a less important factor in determining the priorities.…”

“…Although the goal is mostly to reserve capacity for non-electives (e.g., [24,34,55,87]), the access to the DOR might be limited to trauma orthopedic patients (e.g., [10]), to urgent and semi-urgent patients (e.g., [9]), to add-on cases or to a combination of patient types (e.g., [75,80]). …”

Informal regionalization of pediatric fracture care in the Greater Toronto Area: a retrospective cross-sectional study

“…31, 2015, using the hospital's Surgical Information Systems database (SIS 4.7.10a). 8 We chose the date for the beginning of the study period on the basis of when recording detailed data regarding every surgical case became routine (Appendix 1, available at www.cmajopen.ca/content/5/2/ E468/suppl/DC1).…”