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

## TL;DR

A new system for prioritizing emergency surgeries in a Brazilian hospital reduced waiting times and improved efficiency.

## Contribution

A structured prioritization model combining urgency classification, a Kanban dashboard, and daily meetings was implemented and evaluated.

## Key findings

- Median surgical waiting time decreased from 17h20min to 8h52min after implementation.
- Compliance with acceptable waiting time windows improved from 60.5% to 77.1%.

## Abstract

•A structured prioritization model was implemented for non-elective surgeries in a tertiary academic hospital in Brazil.•The intervention combined urgency classification, a Kanban dashboard, and daily multidisciplinary meetings.•Median surgical waiting time dropped from 17h20min to 8h52min after implementation (p < 0.001).•Compliance with acceptable waiting time windows improved from 60.5 % to 77.1 %.•The model enhanced surgical efficiency and was well-accepted by multidisciplinary teams.

A structured prioritization model was implemented for non-elective surgeries in a tertiary academic hospital in Brazil.

The intervention combined urgency classification, a Kanban dashboard, and daily multidisciplinary meetings.

Median surgical waiting time dropped from 17h20min to 8h52min after implementation (p < 0.001).

Compliance with acceptable waiting time windows improved from 60.5 % to 77.1 %.

The model enhanced surgical efficiency and was well-accepted by multidisciplinary teams.

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.

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.

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).

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.