急诊手术清单效率的图形评估，以确定手术室的容量需求。

A graphical assessment of emergency surgical list efficiency to determine operating theatre capacity needs.

机构信息

Department of Surgery, Royal London Hospital, London, UK.

Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

出版信息

Br J Anaesth. 2022 Mar;128(3):574-583. doi: 10.1016/j.bja.2021.10.033. Epub 2021 Dec 3.

DOI:10.1016/j.bja.2021.10.033

PMID:34865827

Abstract

BACKGROUND

Unlike elective lists, full utilisation of an emergency list is undesirable, as it could prevent patient access. Conversely, a perpetually empty emergency theatre is resource wasteful. Separately, measuring delayed access to emergency surgery from time of booking the urgent case is relevant, and could reflect either deficiencies in patient preparation or be because of an occupied (over-utilised) emergency theatre.

METHODS

We developed a graphical method recognising these two separate but linked elements of performance: (i) delayed access to surgery and (ii) operating theatre utilisation. In a plot of one against the other, data fell into one of four quadrants, with delays associated with high utilisation signifying the need for more emergency capacity. However, delays associated with low utilisation reflect process deficiencies in the emergency patient pathway. We applied this analysis to 73 consecutive lists (>300 cases) from two UK hospitals.

RESULTS

Although both hospitals experienced similar rates of delayed surgery (21.8% vs 21.0%; P=0.872), in one hospital 83% of these were associated with low emergency theatre utilisation (suggesting predominant process deficiencies), whereas in the other 73% were associated with high utilisation (suggesting capacity deficiency; P<0.0001). Increasing emergency capacity in the latter resulted in shorter delays (just 6.7% cases excessively delayed; P<0.0001 for effect of intervention).

CONCLUSIONS

This simple graphical analysis indicates whether more emergency capacity is necessary. We discuss potential applications in managing emergency surgery theatres.

摘要

背景

与择期手术清单不同，充分利用急诊手术清单是不可取的，因为这可能会妨碍患者就诊。相反，急诊手术室永远空着会造成资源浪费。此外，从预约紧急病例到手术的延迟时间反映了患者准备不足，或者是因为手术室被占用（过度利用）。

方法

我们开发了一种图形方法，可识别性能的这两个独立但相关的要素：（i）手术延迟和（ii）手术室利用率。在一个将两者相互对比的图表中，数据落入四个象限之一，高利用率与延迟相关表示需要更多的急诊容量。然而，与低利用率相关的延迟反映了急诊患者路径中的流程缺陷。我们将此分析应用于来自两家英国医院的 73 个连续清单（超过 300 例）。

结果

尽管两家医院的手术延迟率相似（21.8%比 21.0%；P=0.872），但在一家医院，83%的这些延迟与低急诊手术室利用率相关（表明主要是流程缺陷），而在另一家医院，73%的延迟与高利用率相关（表明容量缺陷；P<0.0001）。后者增加急诊容量导致延迟时间缩短（只有 6.7%的病例过度延迟；干预效果的 P<0.0001）。