Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates

Anaesthesia. 2008 Jun;63(6):599-603. doi: 10.1111/j.1365-2044.2008.05441.x.


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.

MeSH terms

  • Communication
  • Emergencies
  • England
  • General Surgery / organization & administration*
  • General Surgery / standards
  • Health Services Research / methods
  • Hospitals, University / organization & administration*
  • Humans
  • Medical Audit
  • Operating Rooms / statistics & numerical data
  • Preoperative Care / standards
  • Surgery Department, Hospital / organization & administration
  • Time Factors
  • Waiting Lists