Operating theatre bottlenecks : how are decisions about emergency theatre schedules made?

The management of emergency services and patient flow is an important and strategic function in hospitals. This paper reports on a study of emergency surgical cases to determine items to be used in subsequent survey questionnaire. Data has revealed that clinical priority is not the sole criterion when triaging emergency surgery. The results provided a conceptual basis to construct a questionnaire to investigate 1) perceptions about clinical priority; 2) perceptions about logistical priority; and 3) perceptions about the relationship of common clinical conditions and time frame within which these conditions must to be attended to, according to individual specialist surgeons, anaesthetists and other staff. This paper details results from the exploratory phase, which aimed to identify the variables for inclusion in the survey questionnaire. In addition, this paper details the pilot results of the questionnaire with 32 clinicians from four hospitals. It is revealed that 1) there is no common, uniform understanding of what constitutes an "emergency"; 2) both clinical and logistic types of criteria are taken into account to determine priority; and 3) processes for decision-making are inconsistently understood. These discrepancies highlight the need and basis for extended research across New South Wales and beyond, with an objective to better understand decisionmaking dynamics in hospital settings.