Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years

Abstract

Background: Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies.

Method: The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied.

Result: We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days.

Conclusion: A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

Keywords: Appointments and schedules; Cancellation; Emergency delays; Operating rooms/organisation and administration; Orthopaedic surgery; Perioperative nursing; Waiting lists.

Fig. 1

Produced and delayed emergency surgery 2007–2013. Emergency surgery waiting list; every new patient is entered into an electronic surgical planning system as a file with a unique patient ID. The patient remains in the planning system until the operation is completed, transferred to another care-giver or the patient did not require surgery. Produced surgery; all the patients who underwent surgery at the current clinic. Delayed patients; all the patients that were delayed. No surgery; surgery on the waiting list that did not undergo surgery at the current clinic

Fig. 2

Reasons for all delayed patients’ emergency surgery 2007–2013

Fig. 3

Waiting time for surgery for all delayed emergency patients by reasons 2007–2013