Timing of emergency surgery at the Kenyatta National Hospital

Abstract

Objective: To establish the timing for surgical emergencies at the Kenyatta National Hospital and review the causes of delay where applicable Study design: A prospective hospital based study Study settings: The study was undertaken at KNH in the 12 main theaters as per inclusion criteria. Materials and method: Data relevant to the study was collected including patient's socio-demographic profile and diagnostic workup, arrival time, theatre notification and time operation began anaesthetist and rank, surgeon and rank, cause of delay where applicable. The data was recorded in the data collection tool. Results and conclusion: About 71.7 % of participants were subjected to waiting time over 4 hours with the commonest cause being occupation of theatre with another emergency. All NCEPOD classes were operated on at all times of the day with no statistical significance between classes when compared over 24 hours. Emergent cases were done faster than urgent and scheduled cases but no statistically significant difference was seen in mean waiting times between urgent and scheduled ·cases. Cases done within regular working hours experienced statistically significant shorter mean waiting times than those done after regular working hours. The presence of a senior surgeon or anaesthetist did not significantly influence mean waiting time. Recommendations: Extra theatres need to be set aside for emergencies including independent orthopaedic and general trauma theatres. Allocation and prioritisation of emergencies in theatre requires training and expertise and senior anaesthetists need to be involved. Protocols as laid down by NCEPOD would be of help in this regard.