[Implementation of emergency classifications-Where do we stand? : Results of a nationwide survey].

Abstract

Background: This study aimed to determine the current state of implementation of the recommendations for the classification of emergency surgery published in 2016 by the German societies of anesthesiology (BDA/DGAI), surgery (BDC/DGCH) and operating room management (VOPM).

Methods: Based on these societies' recommendations, various organizational issues were explored using an online questionnaire that was limited to German operating room (OR) managers and coordinators for hospitals that had surgical programs and at least 200 hospital beds.

Results: A total of 550 hospitals were contacted and 274 participated in the survey (49.8%). Of these 70.7% reported that they had implemented the recommendations, and 15.2% were aware of the recommendations but did not consistently apply them. Of the participating OR managers and coordinators that had either implemented or were aware of the recommendations, 78.2% agreed that the standardized definition of medical emergencies led to improvements in emergency treatment but 33.6% stated that the defined response intervals for emergency categories induced a certain degree of subjectivity in categorizing emergencies. Additional in-house guidelines specifically for the most frequent surgeries were or would be welcomed by 80.1% of the respondents and 39.1% of the surveyed hospitals had already implemented such guidelines. Of the OR managers and coordinators, 62.9% were informed about their emergency volumes and 47.3% stated that they regularly assessed them. There was no dedicated capacity for emergency care in 65.2% of hospitals. Of the respondents 3.9% stated that a separate emergency OR was reserved with a freely available team, which, during core operating hours, could be used for interdisciplinary emergency care and 26.2% of hospitals considered the capacity required for emergency procedures when planning the OR program or determining OR capacities.

Conclusion: The recommendations for classifying emergency operations are an essential and generally accepted control mechanism in OR coordination. They simplify interdisciplinary coordination and communication when dynamically incorporating emergency procedures into an OR program. Most OR managers and coordinators view the recommendations as improving the speed of action in emergency care. To support the adoption of emergency classifications within an organization it may be advisable to incorporate them into the OR statutes and integrate them within the hospital information systems. The majority of participants supported additional specifications based on medical indicators for classifying the most frequent emergency operations. Being cognizant of key metrics concerning in-house emergency volume represents a crucial basis for interdisciplinary OR management and emergency care integration. Contrary to common perception, blocking fixed OR capacities remains the exception. When establishing a concept to provide emergency capacity, it is advisable to align developments with demand calculations based on in-house figures and to emphasize interdisciplinary participation and consensus.