A 10-year analysis of case load and weighted workload in a single Health Board.

This study analysed the general surgical activity in a single Health Board in terms of caseload (case counting) and Intermediate Equivalent (IE) workload. Endoscopy and surgery performed wholly within the specialist vascular and urological units were excluded. Some 180,466 procedures were prospectively recorded through the Lothian Surgical Audit over a 10-year period (1983-92). They have now been weighted to reflect workload according to the British United Provident Association's schedule of procedures. 5,058 (2.8 percent) procedures could not be 'matched' and in a further 2,400 (1.4 percent) there was an error in the Lothian Surgical Audit code leaving 172,968 operations for analysis. The total number of operations (caseload) performed annually fell by 12 percent over the 10-year period. This fall was entirely due to a 28 percent decrease in the number of minor operations. The total annual IE weighted workload rose by 2.7 percent for the 10-year period. Analysis by IE workload revealed that the fall in minor operations had been compensated for by an increase in complex major operations (CMO). The total caseload of CMO had increased from 224 (1.0 percent) to 551 (2.9 percent). This represented an increase in the proportion of workload from 5.3 percent to 12.45 percent. Thus a 1.9 percent increase in case load represented a 7.1 percent increase in IE workload. In the final year major and complex major operations formed 24.6 percent of the caseload which represented 53.2 percent of IE weighted activity. This study suggests that IE workload based on the BUPA schedule is a valid and reproducible method of weighting that accurately reflects the changing workload of different case mixes. This differential must be appreciated to ensure accurate allocation of resources. In future surgical activity,including waiting lists,should be assessed by weighted workload rather than case numbers.