Common Factors of Surgical Delays In The Surgical Environment At A Federal Teaching Hospital In The Southwestern Nigeria

TORG-MAG Vol 1 Issue 2, Dec. 2024, pp. 35-40.
Authors: Adetunji Oluseye Adetayo, Ayedebinu Abiodun O., Bifarin M. Titilope, Oguntoye Oluwaseun (Main Theatre, Clinical Nursing Services, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. African Journal of Health, Nursing and Midwifery, ISSN: 2689-9418)
Cite this article: Adetunji, O. A., Ayedebinu, A. O., Bifarin, M. T., and Oguntoye, O. (2024) ‘Common Factors of Surgical Delays In The Surgical Environment At A Federal Teaching Hospital In The Southwestern Nigeria’, TORG-MAG, Vol. 1, Issue 2, pp. 35-40. Available at: https://torgevents.org/surgical-delays/

Abstract

Surgery is a cost-effective and core component of universal health coverage. Surgical delay is considered to be one of the most upsetting problems affecting patient satisfaction, and it is considered an important challenging issue at most public hospitals as the length of time a patient has to wait after being booked in and registered on the waiting list until the surgery is finally done. The study was a descriptive survey using the quantitative method conducted on Surgical Delays and Associated Factors on Surgical Outcomes among Surgical Teams at Obafemi Awolowo University Teaching Hospitals Complex, Ife Hospital Unit, Ile-Ife, Osun State, Nigeria. Questionnaires and observation checklists were designed as tools to collect the data about surgical delays and associated factors among surgical teams. A total of two hundred and seventy (270) questionnaires were distributed and administered. The data collected were filled and entered into the computer using freeware data entry and validation program known as Epidata 3.0. The finding revealed that the common factors affecting surgical delays among surgical teams include communication gap [Relative Importance Index (RII) = 0.55], clinical instability of the patient (RII = 0.53), non-availability of an operating space (RII = 0.52), and infrastructure problems (RII = 0.52). Communication gap between the surgical team members is the common factor that leads to surgical delays in the health facility. Establishment of perioperative guidelines and protocols as well as review and reinforcement of existing ones are needed to eliminate the attitudinal and systemic causes of surgical delays.

Introduction

Delivering care equally and efficiently with high quality is a challenge, especially in the developing countries. One of the areas affected by these challenges is surgery. Surgical interventions have been reported to account for 60% to 70% of all hospital admissions (Costa, Leão, Novais, & Zucchi, 2015) accruing more than 40% of the total expenses of a hospital (Guerriero & Guido, 2011). Surgical delay is considered to be one of the most upsetting problems affecting patient satisfaction, and it is considered an important challenging issue at most public hospitals as it is the length of time a patient has to wait after being booked in and registered on the waiting list until the surgery is finally done (Amani & Omar, 2017). In African countries, there are known barriers to the provision of safe surgical treatment including low hospital procedural volumes (Rose, Weiser, Hider, Wilson, Gruen, & Bickler, 2015), few hospital beds (Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and HighIncome Countries, 2016) and a scarce number of operating theatres, all of which are compounded by the geographical remoteness of many surgical hospitals and an absence of adequately trained staff (Griffiths, Jones, & Bottle, 2013).

Caribbean Island, Barbados and Jonnalagadda (2005) identified a number of administrative and infrastructural hindrances to the timely performance of elective surgical procedures. The majority of cancellations of elective surgical interventions were due to a shortage of beds, nurses, and recurrent supplies like linen. Chalya et al. (2011) in a comparable setting identified delays in surgical interventions in 81.4% of their series of 3, 064 patients which were due to a lack of operation theatre space and facilities. According to Harders, Malangoni, Weight, and Sidhu (2006), delays in delivery of care can cause negative financial impact on an organisation as well as dissatisfaction among patients and health care workers.

Methodology

Research Design: This study adopted a descriptive survey using quantitative study.
Population: Perioperative team members (Surgeons, anaesthetists, perioperative nurses, and surgical ward nurses) working at OAUTHC, Ile-Ife including nurses working in the surgical wards were the study population. The study was conducted at Ife Hospital Unit of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State between August 2020 and September 2020. OAUTHC is one of the Federal Tertiary health institutions in Nigeria. It serves as a referral centre for other hospitals in the neighbouring states in southwestern Nigeria. The institution is well equipped with new technological structures and highly experienced man-power, including specialised nurses in different fields of care.

Results: Socio-Demographic Data of Study Participants

Table 1 revealed that out of the total respondents used for this study, 106 respondents (40.8%) were males while 154 respondents (59.2%) were females. The table further revealed that the majority of the respondents (90.4%) were Christians while the rest of the respondents (9.6%) were Muslims. The result also shows that the majority of the respondents (39.6%) involved in the study are surgical ward nurses (103 respondents), 75 respondents (28.8%) of the total respondents are theatre nurses and the rest are surgeons and anaesthetists—23.8% and 7.7% of the total respondents respectively. It was finally gathered from the table that 32.7% among the total respondents have between 6–10 years of working experience, followed by 27.7% of the respondents who have less than 5 years of working experience. 23.8% of the respondents have between 11–15 years of working experience, while 15.8% of the total respondents have beyond 16 years of working experience.

Perception of Factors of Surgical Delays among Surgical Team

Source: Researcher’s Field Result (N = 260) Key: Never = (1), Occasionally = (2), Fairly Many Times = (3), Very Often = (4), Always = (5), = Mean, RII = Relative Importance Index

It was indicated that the highest rate admits that the factors of surgical delays among surgical teams was communication gap with RII = 0.55 which was ranked 1st, strictly followed by clinical instability of the patient with RII = 0.53 ranked 2nd. Ranked 3rd was non-availability of an operating space (RII = 0.52); ranked 4th was infrastructure problems with RII = 0.52. Ranked 5th was delay in shifting patients (RII = 0.51).

Others among the factors of surgical delay include lack of proper planning (RII = 0.50), lack of team work (RII = 0.50), awaited laboratory (RII = 0.50), delayed consent to surgery (RII = 0.46), lack of recurrent theatre supplies like oxygen (RII = 0.46), lack of ICU beds (RII = 0.45), failure/lack of equipment (RII = 0.45), lack of preoperative preparation by the surgical team (RII = 0.43), lack of blood supply available for transfusion (RII = 0.41), error in surgical programming/scheduling error (RII = 0.41), unavailability/limited availability of trained supporting staff (RII = 0.41), unknown (RII = 0.40), operating theatre dress unavailability (RII = 0.40), untimely preparation by staff (RII = 0.37), antihypertensive not being given (RII = 0.37), and lack of fasting (RII = 0.36). It further shows that surgeon unavailability was ranked last among the factors of surgical delays, with RII = 0.34. Overall, the perception on the factors of surgical delays among surgical teams at Obafemi Awolowo University Teaching Hospital Complex was quite very low, indicating that few among the surgical team was rated below the RII of 0.34 on a 5-point scale.

Discussion

The finding revealed that the factors affecting surgical delays among surgical teams include communication gap, clinical instability of the patient, non-availability of an operating space and infrastructure problems. The quality and efficiency of surgical procedures and safety are contingent on high quality communication and shared knowledge (Torring, Gittell & Laursen, 2019). The surgical team member communication ought to be improved upon. This finding was corroborated by Oluwadiya et al. (2012) whose findings revealed that the most common cause of delay was delayed transfer of patients from the wards to the theatre, and this occurred in 104 (33.4%) cases. The time spent in transferring patients from the ward ranged between 18% and 54% of the total time spent from ward to the end of surgery. Most delays were due to poor coordination of patients’ movement between the wards and the theatre as well as long distances between the wards and the theatre.

The lengthiest stage during a procedure is anesthesia according to Wu, Brovman, Whang, Ehrenfeld and Urman (2016). The initial anaesthetic preparations led to many delays of patients at the reception areas due to the need to get anaesthetic medications for induction of anaesthesia. The identified causes of surgical delays can be associated with bottlenecks in the existing health system essentials as reported by Kierans, Padilla-Altamira, Garcia-Garcia, Ibarra-Hernandez and Mercado (2013), Hsia, Mbembati, Macfarlane and Kruk (2012) and Adamu, Maigatari, Lawal and Iliyasu (2010) in similar studies. These factors must be reduced to their nearest minimum to reduce the aftereffects of their prevalence on the surgical management systems.

Conclusion

There were experiences of surgical delays in the health facility of study. Communication gap between the surgical team members is the common factor that leads to surgical delays in the health facility. Effective teamwork is highly advocated among the surgical team members.

Recommendations

Based on the findings of this study, the following recommendations are proposed:

Mandatory Pre-Operative Visits: Pre-operative visits by all surgical team members (especially surgeons, anesthetists, and nurses) should be made compulsory. This will ensure that the necessary materials and tests are checked before patients are brought to the operating theatre. Additionally, it will help reduce patients’ anxiety and equip them with the skills to cope with post-operative challenges.

Provision of In-Service Training: All surgical team members should undergo comprehensive in-service training on effective clinical communication systems. The training should include practical sessions to identify potential challenges that lead to communication gaps in the perioperative environment.

Establishment and Reinforcement of Perioperative Guidelines: There is a need to establish new perioperative guidelines and protocols, as well as review and reinforce existing ones, to address both attitudinal and systemic causes of surgical delays.

Dedicated Ambulances for Patient Transfer: Hospitals should provide dedicated ambulances for transferring surgical patients from their admission wards to the operating theatres, especially when the wards are located far from the theatres.

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TORG-MAG Vol 1 Issue 2, Dec. 2024
(Innovating for Tomorrow: The Future of Global Surgical Excellence)
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