Emergency surgery is described as multispecialty surgery done when a patient is hospitalized for either a non-traumatic acute illness or traumatic injuries (1).
Emergency surgery procedures represent a large and unplanned workload for hospitals worldwide. It is estimated that 28% of the global burden in the emergency setting is surgical [1].
National confidential inquiry perioperative death defined as emergency surgery is characterized as a life-saving procedure performed right away, along with resuscitation and surgical care (2).
Acute surgical abdomen are life-threatening emergencies and early presentation of cases to the hospital and prompt surgical treatment of the clinically stabilized patient are imperative to the postoperative survival of the individual(3).
Emergency surgical patients pose problems in initial resuscitation, anesthetic and surgical management, and postoperative care, scarce financial resources and poor organization of available health resources are factors that negatively influence the quality of surgical care in developing countries(4).
Waiting time is defined as the time interval between the time of presentation of the patient at the Emergency Department to the time of the surgical incision of surgery(3). The reasons for emergency procedures result in significant organizational problems for clinics as well as anxiety for the patients. Prolonged waiting times, an overbooked operating room, a lack of hospital beds, and cancellations of emergency surgery at the end of the day are a few problems (5).
Reported that the mortality rates were 4.9% for emergency patients who arrived at OR late and 3.2% for those who arrived on time(6).
In resource-limited settings, surgical care is often delayed due to distance to the clinic, cost of care, resources, roads, availability of healthcare providers, organizational problems, and culturally specific attitudes such as fear of undergoing surgery. Access to care is frequently determined by the patient's total preparation for surgery, which includes the accurate diagnosis, the consent procedure, the necessary funding, and the availability of the required supplies(7).
The timing of admission and the time it took to arrange blood tests were the main reasons for delays in the majority of the studies described, which were then followed by delays in the investigations. According to this research, the main causes of delays were the absence of an operating room, the date of admission, the immediate lack of cross-match blood, and the results of the examinations(8).
All cases of surgical emergency with firm diagnosis needing surgical intervention as part of management should be operated on as early as possible to minimize the risks associated and decrease the postoperative morbidity. In practice, the timing of management is influenced by many factors like clinical diagnosis, complications at the time of presentation, consequences of delay, the workload of surgeons, and the time of hospital admission (day/night)(9).
A study done in Canada in 2009 shows that excessive amount of patient waiting time is disadvantages in that it promotes an unbalanced workload for health professionals, limits the amount of in which a single health professional dedicates to each patient, result in each patient returning home just it comeback to consult the following day or never, increases patients volume, negatively influence staff and examination room availability, results in staff fatigue and dissatisfaction, causes confusion and nervous condition in the waiting area(10) .
Emergencies surgical patients were sometimes delayed or not done due to lack of theatre space, electricity, water, sterile gowns, anesthetic drugs, investigation results and patient’s inability to pay(4). The prolonged waiting time is likely to cause unnecessary suffering and pain and possibly a deterioration in patient health, which might in turn cause delayed or impaired recovery and potentially a less favorable outcome(11, 12).
Justification
The timing of surgical intervention is essential for successful outcomes in emergency surgery. In practice the timing of operative intervention is influenced by many factors including clinical diagnosis, complications of the disease, consequences of delay, the workload of physicians, and availability of theatre space due to this different reason cause for waiting times of emergency surgical patients who undergo operation theater is important for patient satisfaction as well as patient early intervention(13).
Improvement of patient workflow in our hospitals to decrease patient wait time. There hasn’t been a great deal of research in this area that would address patient satisfaction, or lack of, due to prolonged wait time. In our major operation theater, there are a lot of emergency cases with different causes like appendicitis, intestinal obstruction, gunshot injury, and orthopedic procedures.
In this study, we will try to audit the root cause of the waiting time of patients undergoing emergency surgery at Debre Markos Comprehensive Specialized Hospital in major OT to increase patients’ satisfaction, and cost minimize, for reducing intraoperative as well as postoperative morbidity and mortality rates. This study aims to improve the root causes of waiting time for patients who undergo emergency surgical patients at the DMCSH under NSW emergency surgery guidelines.