Dr. Sonia Butterworth
Co-investigators and Collaborators Names:
Dr. Simon Whyte, Dr. Manraj Heran, Dr. Kourosh Afshar
In Canada, elective surgery wait times are frequently measured and reported. However, there is a paucity of literature about wait time data for emergency and urgent surgeries. Presently, no provincial or national policies exist to report surgical wait times for patients requiring surgery in less than 3 days. In the few studies published on this topic, delays to operation have been associated with increased patient morbidity and mortality. A retrospective study at our institution showed over 40% of Class 1 patients (< 1 hour) were delayed and these delays were associated with adverse outcomes. Prospective analysis for all emergency surgery patients with ongoing reporting to stakeholders was undertaken in an attempt to improve access and outcomes. Targets were 60 minutes, 6 hours, 24 hours and 72 hours for Class 1, 2A, 2B and 3 respectively. Reasons for delay were sought by contacting the surgeon, anesthetist as well as charge nurse. High risk for mortality was defined as ASA≥3 &/or meeting SNAPP II or PRISM criteria (validated measures). Morbidity was defined as loss of limb/organ or function related to the surgery. Weekly RN and quarterly physician lead updates were provided and descriptive statistics were used.
Of 1101 cases, 78.4, 91.4 of Class 1, 2A, 2B and 3 achieved targets respectively. The most common reason for delay was no available OR team. Patients at high risk for death experienced delay to OR 15.5 Low Risk). Six delayed patients experienced morbidity.