Van Wyk, Natalie Jean2024-11-132024-11-132023Van Wyk, Natalie Jean. (2023). Audit of a surgical booking system for non-elective cases in a tertiary hospital [Master’s dissertation, University of the Witwatersrand, Johannesburg]. WireDSpace. https://hdl.handle.net/10539/42434https://hdl.handle.net/10539/42434A research report submitted in the partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2023Background South Africa has a particularly large burden of emergency surgical disease, coupled with resource constraints as evidenced by fewer theatres per 100 000 population than the global average. The World Society of Emergency Surgery Study Group Initiative on Timing of Acute Care Surgery (TACS) Classification suggested application of a colour-coded triage system for acute surgical emergencies. TACS developed a ratio of Actual Time to Surgery (aTTS) to Ideal Time to Surgery (iTTS), based on expert opinion for each triage level. It is suggested that each institution examine its aTTS/iTTS ratio as a quality assessment tool, with a target ratio of ≤ 1. Objectives The primary objectives of this study were to describe the time between booking of non- elective operating theatre (OT) cases to the aTTS, denoted by the surrogate of time to theatre, at Chris Hani Baragwanath Academic Hospital and compare it to the iTTS for each colour-coded triage level. The secondary objectives included a description of the total number of non-elective cases per surgical discipline, identification of time differences in preoperative delays between surgical disciplines and age subgroups, and a comparison of preoperative delays for trauma patients against published data from Groote Schuur Hospital. Methods A retrospective clinical audit was conducted in the four dedicated 24-hour theatres of the JD Allen emergency operating theatres (JDA EOTs) over a period of one month. A colour code was added to each booking, at the discretion of the booking surgeon, according to the CHBAH operating theatre triage system (COTTS). The COTTS defined five categories, each with a corresponding iTTS, namely red (immediate), orange (2 hours), yellow (2 to 6 hours), green (24 hours) and blue (72 hours). The aTTS/iTTS ratio was calculated for each triage level. Results The sample size was 435 cases, comprised mostly of general surgery cases (29.7%), followed by orthopaedic surgery (20.1%) and trauma surgery cases (19.5%), respectively. The median aTTS for the red category (with target of immediate aTTS) was 2.1 hours (IQR 1.0 – 4.1 hours). The aTTS/iTTS ratio was 2.75 for the orange category and 2 for the yellow category. The aTTS/iTTS ratio was compliant for the green and blue groups, both with ratios of 0.7. The geriatric group showed the longest aTTS in each triage group and overall. The aTTS for trauma patients at CHBAH was longer for all triage categories than that reported from GSH in 2018. Conclusions This study shows a pattern of prolonged aTTs/iTTs ratios for higher urgency patients and acceptable ratios for lower urgency patients at CHBAH. The geriatric age group showed a longer aTTS for each triage level and overall. Further investigation into reasons for delays and optimal OT utilisation are necessaryen© 2023 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.Surgical booking systemWorld Society of Emergency Surgery Study Group InitiativeUCTDSDG-3: Good health and well-beingDissertationUniversity of the Witwatersrand, Johannesburg