Theatre delay for emergency general surgical patients: a cause for concern?

The delay involved in operating on emergency general surgical patients is often excessive. This problem has been examined prospectively in a district general hospital with a catchment population of 450,000. Over a 16-week period, the details of 204 consecutive general surgical emergency operations were recorded and analysed. Following essential resuscitation, the median delay in operating on emergency general surgical patients was 3 h. Eighty-eight patients had to wait in excess of 1 h, with 15% experiencing a delay of over 6 h. In only 10% of cases was a theatre required after midnight, yet 26% of all emergency general surgical operating was performed between midnight and 8 am. The majority of delays were due to a combination of factors; theatre delay was mentioned in 47% of cases, anesthetic delay in 30% and the overrunning of routine lists in 14% of cases. Our results suggest that unnecessary theatre delay results in an unacceptable number of emergency general surgical operations occurring after midnight. It is important that routine afternoon lists do not overrun, as this contributes directly to evening theatre delay. If both theatre and anaesthetic availability could be ensured in the afternoon and early evening, the after midnight workload could be cut from 26% to 10%, and staff sleep deprivation reduced.