Beyond clinical priority: what matters when making operational decisions about emergency surgical queues?Anneke Fitzgerald A B and Yong Wu A
Australian Health Review - https://doi.org/10.1071/AH16009
Submitted: 22 December 2015 Accepted: 29 June 2016 Published online: 29 August 2016
Objective This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list.
Methods A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants.
Results There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres.
Conclusions Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians’ indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations.
What is known about the topic? Tensions exist about the efficient use of operating theatres and negotiating individual surgeon’s demands, especially between surgeons and managers, because in many countries surgeons only work in the hospital and not for the hospital.
What does this paper add? The present study examined the logistical effects on functionality and purports the notion that, while recognising the importance of clinical precedence, logistical factors influence queue order to ensure efficient use of operating theatre resources.
What are the implications for practitioners? The results indicate that there are differences in the perceptions of healthcare professionals regarding the sequencing of emergency patients. These differences may lead to conflicts in the decision making process about triaging emergency or unplanned surgical cases. A clear understanding of the different perceptions of different functional groups may help address the conflicts that often arise in practice.
References Western Canada Waiting List (WCWL) Project. From chaos to order: making sense of waiting lists in Canada. Edmonton: WCWL Project, University of Alberta; 2001.
 Hadley R, Forster D. Doctors as managers: experiences in the front-line of the NHS. Harlow: Longman; 1993.
 NSW Health Council. Report of the NSW Health Council. Sydney: NSW Health; 2000. www.health.nsw.gov.au/pubs/2000/pdf/Health_Council_Report.pdf [verified 13 May 2012].
 Fitzgerald JA, Lum M, Dadich A. Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists. Aust Health Rev 2006; 30 219–31.
| Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists.CrossRef |
 Mazzei WJ, Blasco T. What’s the best way to manage urgent and emergent OR cases? OR Manager 2005; 21 1–12.
 Pham H. Decision making in operating theatres: the management of unplanned surgery. Masters Thesis, University of Twente, Enschede, The Netherlands; 2007.
 Glouberman S, Mintzberg H. Managing the care of health and the cure of disease – Part I: differentiation. Health Care Manage Rev 2001; 26 56–9.
| Managing the care of health and the cure of disease – Part I: differentiation.CrossRef | 1:STN:280:DC%2BD3M3ksFShuw%3D%3D&md5=3d4add2a9f4d82dff6fa7124e2a1d151CAS | 11233354PubMed |
 Hoffer Gittell J. Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance effects. Manage Sci 2002; 48 1408–26.
| Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance effects.CrossRef |
 Glouberman S, Mintzberg H. Managing the care of health and the cure of disease – Part II: integration. Health Care Manage Rev 2001; 26 70–84.
| Managing the care of health and the cure of disease – Part II: integration.CrossRef | 1:STN:280:DC%2BD3M3ksFSgsw%3D%3D&md5=1bb47014c34195b2f427f7edb2158e01CAS | 11233356PubMed |
 Fitzgerald JA, Lum M, Kippist L. Operating theatre bottlenecks: how are decisions about emergency theatre schedules made. 5th International CINet Conf; Sydney, Australia; 2004.
 Lum ME, Fitzgerald JA. Priority emergency cases: are anaesthetists intermediaries in inter-professional warfare within the operating theatre. Aust and N Z College of Anaesthetists Annual Scientific Meeting, 16–18 May 2006; Adelaide Convention Centre; 2006.
 Fitzgerald JA, Dadich A, Lum M. Operating theatre gridlock: how are decisions made on emergency surgical cases. Asia Pac J Health Manage 2007; 2 21–9.
 Wong J, Khu KJ, Kaderali Z, Bernstein M. Delays in the operating room: signs of an imperfect system. Can J Surg 2010; 53 189–95.
| 20507792PubMed |
 George D, Mallery P. SPSS for Windows step by step: a simple guide and reference. 4th edn. Boston: Allyn & Bacon; 2003.
 Nunnally JC, Bernstein IH. Psychometric Theory. 3rd edn. New York: McGraw Hill; 1994.
 Dexter F, Epstein RH, Traub RD, Xiao Y. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times. Anesthesiology 2004; 101 1444–53.
| Making management decisions on the day of surgery based on operating room efficiency and patient waiting times.CrossRef | 15564954PubMed |
 Wood KM, Matthews GE. Overcoming the physician group–hospital cultural gap. Healthc Financ Manage 1997; 51 69–70.
| 1:CAS:528:DyaK2sXmsl2mtrY%3D&md5=241409078fbde207de71e8c2baa3bf00CAS | 10165442PubMed |
 Waldman JD, Cohn KH. Mending the gap between physicians and hospital executives. In: Cohn KH, Hough DE, editors. The business of healthcare. Westport: Praeger Publishers; 2007. pp. 27–57.
 McDonald R, Waring J, Harrison S. Rules, safety and the narrativisation of identity: a hospital operating theatre case study. Sociol Health Illn 2006; 28 178–202.
| Rules, safety and the narrativisation of identity: a hospital operating theatre case study.CrossRef | 16509952PubMed |
 Ebertowski S, Hillyer L, Inbar-Metrokin G, Noll D. Good policies are guide to add-on surgical cases. OR Manager 1999; 15 29–32.
| 1:STN:280:DyaK1M3isVKhuw%3D%3D&md5=da1a628b3ee537f58a7d69932fea4b00CAS |
 Hunter DJ. Doctors as managers: poachers turned gamekeepers? Soc Sci Med 1992; 35 557–66.
| Doctors as managers: poachers turned gamekeepers?CrossRef | 1:STN:280:DyaK38zptVOluw%3D%3D&md5=f37bad1f67457d28ff7598b00dc30776CAS | 1519109PubMed |
 Maister DH. The psychology of waiting lines. In: Czepiel JA, Solomon MR, Suprenant CF, editors. The service encounter. Lexington: Lexington Books; 1985. pp. 113–24.
 Organization For Economic Cooperation and Development (OECD). Health care systems: getting more value for money. OECD Economics Department policy notes, no. 2. Paris: OECD; 2010.
 Mitchell RK, Agle BR, Wood DJ. Toward a theory of stakeholder identification and salience: defining the principle of who and what really counts. Acad Manage Rev 1997; 22 853–86.
 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 505–16.
| The impact of electronic health records on time efficiency of physicians and nurses: a systematic review.CrossRef | 15905487PubMed |
 DesRoches CM, Campbell EG, Vogeli C, Zheng J, Rao SR, Shields AE, Donelan K, Rosenbaum S, Bristol SJ, Jha AK. Electronic health records’ limited successes suggest more targeted uses. Health Aff 2010; 29 639–46.
| Electronic health records’ limited successes suggest more targeted uses.CrossRef |
 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl J Med 2009; 360 1628–38.
| Use of electronic health records in U.S. hospitals.CrossRef | 1:CAS:528:DC%2BD1MXkvVKlsr0%3D&md5=4fb24fcf17359c6e23300bd5ec2e0458CAS | 19321858PubMed |
 Cotea C. Electronic health record adoption: perceived barriers and facilitators. Technical report. Brisbane: Centre for Military and Veterans’ Health, The University of Queensland; 2010.