Clinical audit on the root cause analysis of waiting time for surgical patients who undergo emergency surgery in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2023

Clinical audit on the root cause analysis of waiting time for surgical patients who undergo emergency surgery in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical audit on the root cause analysis of waiting time for surgical patients who undergo emergency surgery in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2023 Yitayal Guadie, Yohannes Godie, Melese Tadele This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4267809/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Emergency surgery is characterized as a life-saving procedure performed right away, along with resuscitation and surgical care. The study aims to improve the root causes of waiting time for patients who undergo emergency surgical patients. Methodology : All consecutive emergency surgical patients who undergo emergency surgery are included in the study period. The data were checked, coded, entered, and cleaned by using SPSS version 20. Descriptive analysis was performed using SPSS version 20. Results will be expressed in graphs, frequencies, and percentages. All the data were collected based on NSW emergency surgery guidelines and based on literature review data collection formats and directly changed into open-ended question forms. Result A total of 50 surgical emergency patients were operated in a major operation theater at Debre Markos Comprehensive Specialized Hospital during the study period. Thirty-nine (78%) of surgical emergency patients had prolonged wait times with a mean of 8 hours with a standard deviation of 4.44. Of those the cause of waiting time was around 22% due to preoccupation with the operation theater, 18% due to lack of OR supplies like Gown/drip, and water, 16% due to financial constraints and logistics of the patients, 12%patients delayed giving consent, 12%patient delayed due to procedures need special intervention. Conclusion and Recommendation The mean waiting time of emergency surgical patients who undergo emergency surgery in the Debre Markos Compressive and Specialized Hospital was 8 hrs. with a standard deviation of 4.44. A total of 78% of emergency surgical patients experience prolonged waiting times because of their preoccupation with the operation theater. Prioritization of emergency cases following emergency surgery guidelines is required in the Debre Markos compressive and specialized hospital to replace the current system. Emergency surgery Waiting time clinical audit Figures Figure 1 Figure 2 Introduction 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. Methods and Materials Population All emergency surgical patients who undergo emergency surgery in the major surgical operation theater. Inclusion criteria: Emergency surgical patients who were done in the major surgical operation theater. Exclusion criteria Those patients who were admitted for observation and patients who needed prolonged initial resuscitation due to disease process or co-morbidity were excluded from the study. Sample size All emergency surgical patients undergoing emergency surgery in the major operation theater at Debre Markos Comprehensive Specialized Hospital were audited from 1/07/2015 to 30/07/2015 E. C. Sampling technique Consecutive emergency surgical patients who undergo emergency surgery. Data collection method This audit was conducted at DMCSH in a major surgical operation theater located in Debre Markos, Ethiopia. Data collection tools were on patient interviews and chart review based on standard literature checklist review ( 9 , 15 , 16 ) and NSW guidelines in the major operation theater( 14 ). The data were checked, coded, entered, and cleaned by using SPSS version 20. Descriptive analysis was performed using SPSS version 20. Results will be expressed in graphs, frequencies, and percentages. All the data were collected based on NSW emergency surgery guidelines and based on literature review data collection formats and directly changed into open-ended question forms. Result A total of 50 patients were operated in the major operation room for emergency surgery during the study period. Fifty patients who fulfilled the inclusion criteria were enrolled. Diagnosis of all patients are shown in Table-1. Thirty-nine (78%) patients had to prolonged waiting with the mean of 8 hours with standard deviation of 4.4. From those the cause of waiting time around 22% due to preoccupation with the operation theater, 18% due to lack of OR supplies like Gown/drip, and water, 16% due to financial constraints and logistics of the patients, 12% patients delayed giving consent, 12% procedures need special intervention the most cause of patients prolonged waiting time. Table 1 Diagnosis of patients Diagnosis Frequency Percent Acute appendicitis 15 30% Intestinal obstruction 9 18% Abscess 4 8% Obstructed hernia 4 8% Perforated PUD 4 8% Soft tissue injury 4 8% Fracture 3 6% Blunt abdominal injury 2 4% Gun shout 2 4% Testicular torsion 1 2% Acute Cho cholangitis 1 2% Diverticulitis 1 2% Table 2 Urgency of surgery depends on the NSW guideline on emergency surgery Urgency of surgery Frequency Percent Critical 21 42.0% Urgent 25 50.0% semi-urgent 4 8.0% Total 50 100.0% Discussion In a study done in Sweden eighty percent of these delays were due to organizational causes. Twenty-one percent of all the delayed patients had surgery within 24 hours, whilst 41% waited for more than 24 hours, up to 3 days( 17 ). However, our audit shows 78% (39) patients prolonged waiting time for emergency surgery due to preoccupation with the operation theater with a mean of 8 hrs. with a standard deviation of 4.44. In a study done in Pakistan 42% (40) of patients waited for more than 3 hrs. due to the cause of the time of admission ( 9 ), but in our study, 22% of the patients waited for a mean of 8 hrs. due to the cause of preoccupation of the operation theater. Many studies have shown that the longer the waiting time for emergency surgery more is the morbidity and mortality( 18 ). A study from Libreville hospital center showed that 54.2% patients had some delays in the management of surgical emergencies( 19 ) . Prospective observational study done in Nigeria the waiting time of emergency surgery based on emergency surgery guidelines 81.6% of operative interventions was delayed beyond 6 hours of which financial constraints accounted for 53.8% in this study the total mean time of waiting time between mean of 22.3 ± 10.0 hours( 3 ). These results were different in an observational study done in Kenya about 77.1% of the patients waiting for emergency surgery over 4 hours for the commonest cause of occupation of operation theater. In our audit twenty-five (50%) of the patients were urgent, twenty-one (42%) of patients were critical, and four (8%) patients were semi urgent. From those cases according to the NSW guideline eighty-four (78%) patients have prolonged waiting time with the mean time of 8 hours. The cause of prolonged waiting time was around 22% due to preoccupation with the operation theater, 16% due to financial constraints and logistics of the patients, 18% due to lack of OR supplies like Gown/drip, water, patients delayed giving consent 12%, procedures need special intervention 12% cause for patient waited for a prolonged time. The reason for prolonged waiting time is due to not having adequate operation room as compared with the number of case flow of emergency surgical patients. Another reason, may not have available NSW guidelines is due to time limitations or lack of awareness or visibility of the guideline, OR not available local guidelines on emergency surgery waiting time. Conclusion The mean waiting time of emergency surgical patients who undergo emergency surgery in DMCSH was 8 hrs. with a standard deviation of 4.44. A total of 78% of emergency surgical patients experience prolonged waiting times because of their preoccupation with the operation theater. The majority of cases were acute appendicitis during the study. This is an indication of the large workload and hence shortage of operation theater. Recommendation Prioritization of emergency cases following emergency surgery guidelines is required in DMCSH to replace the current system. Develop standard local emergency surgery guidelines which helps to consider the consequence of waiting patients between the decision that an operation is required and surgery taking place should be applied to the patient before theater allocation in Debre Markos Comprehensive Specialized Hospital. More emergency operation theaters are needed in major surgical operation theaters because the most common cause for prolonged waiting time was a preoccupation with the operation theater in another case. In addition, concreted attempts to improve theater efficiency should be made. Abbreviations NSW North South Wales emergency surgery guideline OT Operation theater DMCSH Debe Markos Comprehensive Specialized hospital WJES World journal of emergency surgery Declarations Ethics approval Ethical approval was obtained from the Ethical Review Committee of the College of Medicine and Health Science, Deber Markos University, and informed consent was waived by the ethics committee. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Conflict of interest The authors declare that they have no competing interests in this section. Source of Funding This research did not receive any specific grant from funding agencies. Authors’ Contribution All Authors conceptualized, designed the study, collected, analysed, and interpreted the data, and also drafted the manuscript. Data analysis, drafting of the manuscript, and advising the whole research paper and also involved in the interpretation of the data and contributed to manuscript preparation. All authors read and approved the final manuscript. Acknowledgment We would like to say thanks to Debre Markos University for giving ethical clearance and to Debre Markos Comprehensive Specialized Hospital for its positive response. Our heartfelt thanks also go to all the data collectors for their valuable contribution to the realization of this study. References Catena F, Moore EE Jr. World Journal of Emergency Surgery (WJES), World Society of Emergency Surgery (WSES), and the role of emergency surgery in the world. World J Emerg Surg. 2007;2:3. COMM R, TA I. TI L. National Confidential Enquiry Into Patient Outcome And Death. Mbah N, Opara W, Agwu N. Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences. Nigerian J Surg Res. 2006;8(1). Eguma S, Kalba D. An audit of emergency anaesthesia and surgery. Nigerian J Surg Res. 2003;5(3):140–7. Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, et al. Global access to surgical care: a modelling study. Lancet Global Health. 2015;3(6):e316–23. McIsaac DI, Abdulla K, Yang H, Sundaresan S, Doering P, Vaswani SG, et al. Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study. CMAJ. 2017;189(27):E905–12. Grimes CE, Bowman KG, Dodgion CM, Lavy CB. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941–50. Löfvendahl S, Eckerlund I, Hansagi H, Malmqvist B, Resch S, Hanning M. Waiting for orthopedic surgery: factors associated with waiting times and patients’ opinion. Int J Qual Health Care. 2005;17(2):133–40. Jawaid M, Amin MF, Khan RA, Iqbal SA. An audit of reduction in waiting time for emergency surgeries in a tertiary care teaching hospital. Pakistan J Med Sci. 2005;21(4):422. Santibáñez P, Chow VS, French J, Puterman ML, Tyldesley S. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Manag Sci. 2009;12:392–407. Dickerson SS, Alqaissi N, Underhill M, Lally RM. Surviving the wait: defining support while awaiting breast cancer surgery. J Adv Nurs. 2011;67(7):1468–79. Magnusson H, Felländer-Tsai L, Hansson MG, Ryd L. Cancellations of elective surgery may cause an inferior postoperative course: the ‘invisible hand ’ of health-care prioritization? Clin Ethics. 2011;6(1):27–31. Chianakwana GU, Ihegihu CC, Okafor PI, Anyanwu SN, Mbonu OO. Adult surgical emergencies in a developing country: the experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. World J Surg. 2005;29(6):804–7. discussion 8. Deane SA, MacLellan DG, Meredith GL, Cregan PC. Making sense of emergency surgery in New South Wales: a position statement. ANZ J Surg. 2010;80(3):139–44. MF A, RA K. SA I. Waiting time for emergency surgeries in a tertiary care public hospital performance audit. 2005. Acharya SP, Dharel D, Upadhyaya S, Khanal N, Dahal S, Dahal S, et al. Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal. J Soc Anesthesiologists Nepal. 2014;1(1):7–12. Caesar U, Karlsson J, Hansson E. Incidence and root causes of delays in emergency orthopedic procedures: a single-center experience of 36,017 consecutive cases over seven years. Patient Saf Surg. 2018;12(1):1–10. Olsen DB, Pedersen PU, Noergaard MW. Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review. JBI Evid synthesis. 2023. 10.11124. Zué AS, Josseaume A, Nsafu DN, Galoisy-Guibal L, Carpentier J, editors. Surgical emergencies at Libreville Hospital Center. Annales Francaises D'anesthesie et de Reanimation; 2003. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4267809","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291828223,"identity":"7d378511-a98d-40aa-a4c6-967506803393","order_by":0,"name":"Yitayal Guadie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYJACiQQGBh4w60EFkGBmbiBOC1hPwhmQFkYitIAIsJbENhBJQIt8RPLDGw8qDsvYs58x/JA4rzaavx2o5UfFNpxaDG+kGVsknDnMw8OTYyyRuO147ozDjA2MPWdu49YyI8FMIrENqIUhxwCo5VhuA1ALM2MbPi3p3yQS/wG18L8x/pE451jufEJa5CVygLY0ALVAGDW5GwhpMeB5U2yRcCydh+fGszIg40DuRqCWg/j8It+evvHmjxpre/b+5M03PtTU5c47f/jggx8VeGw5AKaagZjDAEgcBnMP4FQPsqUBTNUBMfsDKGMUjIJRMApGASoAAGbqXaNO+XhxAAAAAElFTkSuQmCC","orcid":"","institution":"Debre Markos University","correspondingAuthor":true,"prefix":"","firstName":"Yitayal","middleName":"","lastName":"Guadie","suffix":""},{"id":291828224,"identity":"36d11a9f-1332-4861-9a9d-472ac04aaec8","order_by":1,"name":"Yohannes Godie","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"prefix":"","firstName":"Yohannes","middleName":"","lastName":"Godie","suffix":""},{"id":291828225,"identity":"757acfc8-963a-4671-9252-2ec85444e07f","order_by":2,"name":"Melese Tadele","email":"","orcid":"","institution":"Borumeda General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Melese","middleName":"","lastName":"Tadele","suffix":""}],"badges":[],"createdAt":"2024-04-15 07:06:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4267809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4267809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55321453,"identity":"0f061006-5a4a-49cb-866d-84bcf06ecf71","added_by":"auto","created_at":"2024-04-25 16:22:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20443,"visible":true,"origin":"","legend":"\u003cp\u003ewaiting time for emergency surgical patients who undergo emergency surgery in major operation theater.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4267809/v1/bd6f9ab39d3e33485412b203.png"},{"id":55321454,"identity":"d7c8b563-ad8d-40df-bfb7-5b7efa95701d","added_by":"auto","created_at":"2024-04-25 16:22:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46710,"visible":true,"origin":"","legend":"\u003cp\u003eCause of prolonged waiting time for surgical patients who undergo emergency surgery in major operation theater.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4267809/v1/3bbadd731583f9fd02a56d95.png"},{"id":58961204,"identity":"c0a43cd0-1ed9-4fa0-aee6-9ead80314ce1","added_by":"auto","created_at":"2024-06-24 16:24:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":427955,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4267809/v1/ebe46ba5-6d7b-4e7f-b19c-e549c7917dc3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical audit on the root cause analysis of waiting time for surgical patients who undergo emergency surgery in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmergency surgery is described as multispecialty surgery done when a patient is hospitalized for either a non-traumatic acute illness or traumatic injuries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmergency 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 [\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNational confidential inquiry perioperative death defined as emergency surgery is characterized as a life-saving procedure performed right away, along with resuscitation and surgical care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcute 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(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmergency 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(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWaiting 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(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). 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 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReported that the mortality rates were 4.9% for emergency patients who arrived at OR late and 3.2% for those who arrived on time(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 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(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 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(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll 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)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA 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(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eEmergencies surgical patients were sometimes delayed or not done due to lack of theatre space, electricity, water, sterile gowns, anesthetic drugs, investigation results and patient\u0026rsquo;s inability to pay(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). 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(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eJustification\u003c/h2\u003e \u003cp\u003eThe 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(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImprovement of patient workflow in our hospitals to decrease patient wait time. There hasn\u0026rsquo;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.\u003c/p\u003e \u003cp\u003eIn 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\u0026rsquo; 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eAll emergency surgical patients who undergo emergency surgery in the major surgical operation theater.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria:\u003c/h2\u003e \u003cp\u003eEmergency surgical patients who were done in the major surgical operation theater.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eThose patients who were admitted for observation and patients who needed prolonged initial resuscitation due to disease process or co-morbidity were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eAll emergency surgical patients undergoing emergency surgery in the major operation theater at Debre Markos Comprehensive Specialized Hospital were audited from 1/07/2015 to 30/07/2015 E. C.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eConsecutive emergency surgical patients who undergo emergency surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eData collection method\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis audit was conducted at DMCSH in a major surgical operation theater located in Debre Markos, Ethiopia. Data collection tools were on patient interviews and chart review based on standard literature checklist review (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and NSW guidelines in the major operation theater(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The data were checked, coded, entered, and cleaned by using SPSS version 20. Descriptive analysis was performed using SPSS version 20. Results will be expressed in graphs, frequencies, and percentages. All the data were collected based on NSW emergency surgery guidelines and based on literature review data collection formats and directly changed into open-ended question forms.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eA total of 50 patients were operated in the major operation room for emergency surgery during the study period. Fifty patients who fulfilled the inclusion criteria were enrolled. Diagnosis of all patients are shown in Table-1. Thirty-nine (78%) patients had to prolonged waiting with the mean of 8 hours with standard deviation of 4.4. From those the cause of waiting time around 22% due to preoccupation with the operation theater, 18% due to lack of OR supplies like Gown/drip, and water, 16% due to financial constraints and logistics of the patients, 12% patients delayed giving consent, 12% procedures need special intervention the most cause of patients prolonged waiting time.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiagnosis of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute appendicitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstructed hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforated PUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft tissue injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlunt abdominal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGun shout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTesticular torsion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute Cho cholangitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiverticulitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUrgency of surgery depends on the NSW guideline on emergency surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUrgency of surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCritical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esemi-urgent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a study done in Sweden eighty percent of these delays were due to organizational causes. Twenty-one percent of all the delayed patients had surgery within 24 hours, whilst 41% waited for more than 24 hours, up to 3 days(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). However, our audit shows 78% (39) patients prolonged waiting time for emergency surgery due to preoccupation with the operation theater with a mean of 8 hrs. with a standard deviation of 4.44.\u003c/p\u003e \u003cp\u003eIn a study done in Pakistan 42% (40) of patients waited for more than 3 hrs. due to the cause of the time of admission (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), but in our study, 22% of the patients waited for a mean of 8 hrs. due to the cause of preoccupation of the operation theater. Many studies have shown that the longer the waiting time for emergency surgery more is the morbidity and mortality(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A study from Libreville hospital center showed that 54.2% patients had some delays in the management of surgical emergencies(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eProspective observational study done in Nigeria the waiting time of emergency surgery based on emergency surgery guidelines 81.6% of operative interventions was delayed beyond 6 hours of which financial constraints accounted for 53.8% in this study the total mean time of waiting time between mean of 22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0 hours(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese results were different in an observational study done in Kenya about 77.1% of the patients waiting for emergency surgery over 4 hours for the commonest cause of occupation of operation theater.\u003c/p\u003e \u003cp\u003eIn our audit twenty-five (50%) of the patients were urgent, twenty-one (42%) of patients were critical, and four (8%) patients were semi urgent. From those cases according to the NSW guideline eighty-four (78%) patients have prolonged waiting time with the mean time of 8 hours. The cause of prolonged waiting time was around 22% due to preoccupation with the operation theater, 16% due to financial constraints and logistics of the patients, 18% due to lack of OR supplies like Gown/drip, water, patients delayed giving consent 12%, procedures need special intervention 12% cause for patient waited for a prolonged time.\u003c/p\u003e \u003cp\u003eThe reason for prolonged waiting time is due to not having adequate operation room as compared with the number of case flow of emergency surgical patients. Another reason, may not have available NSW guidelines is due to time limitations or lack of awareness or visibility of the guideline, OR not available local guidelines on emergency surgery waiting time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe mean waiting time of emergency surgical patients who undergo emergency surgery in DMCSH was 8 hrs. with a standard deviation of 4.44. A total of 78% of emergency surgical patients experience prolonged waiting times because of their preoccupation with the operation theater. The majority of cases were acute appendicitis during the study. This is an indication of the large workload and hence shortage of operation theater.\u003c/p\u003e "},{"header":"Recommendation","content":"\u003cp\u003e Prioritization of emergency cases following emergency surgery guidelines is required in DMCSH to replace the current system.\u003c/p\u003e\u003cp\u003e Develop standard local emergency surgery guidelines which helps to consider the consequence of waiting patients between the decision that an operation is required and surgery taking place should be applied to the patient before theater allocation in Debre Markos Comprehensive Specialized Hospital.\u003c/p\u003e\u003cp\u003eMore emergency operation theaters are needed in major surgical operation theaters because the most common cause for prolonged waiting time was a preoccupation with the operation theater in another case. In addition, concreted attempts to improve theater efficiency should be made.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e NSW North South Wales emergency surgery guideline\u003c/p\u003e \u003cp\u003eOT Operation theater\u003c/p\u003e \u003cp\u003eDMCSH Debe Markos Comprehensive Specialized hospital\u003c/p\u003e \u003cp\u003eWJES World journal of emergency surgery\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Review Committee of the College of Medicine and Health Science, Deber Markos University, and informed consent was waived by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll Authors conceptualized, designed the study, collected, analysed, and interpreted the data, and also drafted the manuscript. Data analysis, drafting of the manuscript, and advising the whole research paper and also involved in the interpretation of the data and contributed to manuscript preparation. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to say thanks to Debre Markos University for giving ethical clearance and to Debre Markos Comprehensive Specialized Hospital for its positive response. Our heartfelt thanks also go to all the data collectors for their valuable contribution to the realization of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCatena F, Moore EE Jr. World Journal of Emergency Surgery (WJES), World Society of Emergency Surgery (WSES), and the role of emergency surgery in the world. World J Emerg Surg. 2007;2:3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOMM R, TA I. TI L. National Confidential Enquiry Into Patient Outcome And Death.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbah N, Opara W, Agwu N. Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences. Nigerian J Surg Res. 2006;8(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEguma S, Kalba D. An audit of emergency anaesthesia and surgery. Nigerian J Surg Res. 2003;5(3):140\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, et al. Global access to surgical care: a modelling study. Lancet Global Health. 2015;3(6):e316\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcIsaac DI, Abdulla K, Yang H, Sundaresan S, Doering P, Vaswani SG, et al. Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score\u0026ndash;matched observational cohort study. CMAJ. 2017;189(27):E905\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimes CE, Bowman KG, Dodgion CM, Lavy CB. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026ouml;fvendahl S, Eckerlund I, Hansagi H, Malmqvist B, Resch S, Hanning M. Waiting for orthopedic surgery: factors associated with waiting times and patients\u0026rsquo; opinion. Int J Qual Health Care. 2005;17(2):133\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJawaid M, Amin MF, Khan RA, Iqbal SA. An audit of reduction in waiting time for emergency surgeries in a tertiary care teaching hospital. Pakistan J Med Sci. 2005;21(4):422.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantib\u0026aacute;\u0026ntilde;ez P, Chow VS, French J, Puterman ML, Tyldesley S. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency\u0026rsquo;s ambulatory care unit through simulation. Health Care Manag Sci. 2009;12:392\u0026ndash;407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDickerson SS, Alqaissi N, Underhill M, Lally RM. Surviving the wait: defining support while awaiting breast cancer surgery. J Adv Nurs. 2011;67(7):1468\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagnusson H, Fell\u0026auml;nder-Tsai L, Hansson MG, Ryd L. Cancellations of elective surgery may cause an inferior postoperative course: the \u0026lsquo;invisible hand \u0026rsquo; of health-care prioritization? 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Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal. J Soc Anesthesiologists Nepal. 2014;1(1):7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaesar U, Karlsson J, Hansson E. Incidence and root causes of delays in emergency orthopedic procedures: a single-center experience of 36,017 consecutive cases over seven years. Patient Saf Surg. 2018;12(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsen DB, Pedersen PU, Noergaard MW. Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review. JBI Evid synthesis. 2023. 10.11124.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZu\u0026eacute; AS, Josseaume A, Nsafu DN, Galoisy-Guibal L, Carpentier J, editors. Surgical emergencies at Libreville Hospital Center. Annales Francaises D'anesthesie et de Reanimation; 2003.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Emergency surgery, Waiting time, clinical audit","lastPublishedDoi":"10.21203/rs.3.rs-4267809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4267809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmergency surgery is characterized as a life-saving procedure performed right away, along with resuscitation and surgical care. The study aims to improve the root causes of waiting time for patients who undergo emergency surgical patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e: All consecutive emergency surgical patients who undergo emergency surgery are included in the study period. The data were checked, coded, entered, and cleaned by using SPSS version 20. Descriptive analysis was performed using SPSS version 20. Results will be expressed in graphs, frequencies, and percentages. All the data were collected based on NSW emergency surgery guidelines and based on literature review data collection formats and directly changed into open-ended question forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 50 surgical emergency patients were operated in a major operation theater at Debre Markos Comprehensive Specialized Hospital during the study period. Thirty-nine (78%) of surgical emergency patients had prolonged wait times with a mean of 8 hours with a standard deviation of 4.44. Of those the cause of waiting time was around 22% due to preoccupation with the operation theater, 18% due to lack of OR supplies like Gown/drip, and water, 16% due to financial constraints and logistics of the patients, 12%patients delayed giving consent, 12%patient delayed due to procedures need special intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean waiting time of emergency surgical patients who undergo emergency surgery in the Debre Markos Compressive and Specialized Hospital was 8 hrs. with a standard deviation of 4.44. A total of 78% of emergency surgical patients experience prolonged waiting times because of their preoccupation with the operation theater. Prioritization of emergency cases following emergency surgery guidelines is required in the Debre Markos compressive and specialized hospital to replace the current system.\u003c/p\u003e","manuscriptTitle":"Clinical audit on the root cause analysis of waiting time for surgical patients who undergo emergency surgery in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-25 16:22:01","doi":"10.21203/rs.3.rs-4267809/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ef94d7b-78cc-470f-900c-b9b76c6bfa81","owner":[],"postedDate":"April 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-24T16:16:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-25 16:22:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4267809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4267809","identity":"rs-4267809","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}