Impact of implementing a prioritization process on waiting time for non-scheduled surgeries in a tertiary emergency unit

Abstract

Objectives  To evaluate the impact of implementing a structured prioritization process on surgical waiting times and compliance with time-to-intervention targets for non-elective surgeries in a tertiary academic emergency hospital.

Methods  This observational retrospective single-center cohort study compared two periods before and after implementing a prioritization system. All non-elective surgeries performed from June to August 2022 (pre-intervention) and from November 2022 to January 2023 (post-intervention) were analyzed. The intervention included urgency classification, a real-time Kanban dashboard, and daily multidisciplinary scheduling meetings. The primary outcome was the median time from surgical indication until surgical procedure. The secondary outcome included adherence to predefined acceptable waiting time windows. Statistical comparisons were performed using Chi-Square, Fisher's exact, or Mann-Whitney U tests. A significance level of p < 0.05 was adopted.

Results  1851 surgeries were analyzed (967 pre-implementation and 884 post-implementation). The median waiting time was significantly reduced from 17h20min to 8h52min (p < 0.001). Compliance with acceptable waiting time windows increased from 60.5 % to 77.1 % (OR = 2.205; 95 % CI 1.799-2.701).

Conclusions  Introducing a structured prioritization strategy significantly reduced waiting times and improved adherence to surgical timelines in a high-complexity emergency environment. The model proved feasible, effective, and well-accepted by multidisciplinary teams. The long-term impact of the implementation of the model could be further addressed in future studies.