Resource management strategies for prioritizing non-scheduled surgical procedures in a tertiary public hospital

Resource management strategies for prioritizing non-scheduled surgical procedures in a tertiary public hospital Healthcare systems worldwide face the perennial challenge of balancing patient demand with finite resources, a struggle exacerbated in tertiary hospitals like the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP).As a leading referral center serving millions in São Paulo and beyond, HC-FMUSP confronts the complex task of managing non-scheduled surgical procedures amidst high clinical acuity and resource variability. 1 At Instituto Central of HC-FMUSP, the demand for emergency surgical services is intense, with over 42,000 emergency visits annually and approximately 280 non-scheduled surgeries per month.This volume underscores the critical need for efficient resource allocation, particularly in the operation theaters available around the clock.Historically, decisions regarding surgery prioritization were decentralized, relying heavily on individual physician judgment.This approach led to inconsistencies, inefficiencies, team discord and challenges in surgical planning, impacting patient care and staff satisfaction.The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) introduced a classification system categorizing surgeries by urgency -IMMEDIATE, URGENT, EXPEDITED, and ELECTIVEbased on clinical severity and need for immediate intervention.This framework provides clarity and consistency in prioritizing surgeries critical to patient survival and organ function preservation.2,3 Similarly, the World Society of Emergency Surgery (WSES) proposed the Timing of Acute Care Surgery (TACS) classification, which categorizes surgeries based on time framesranging from immediate to over 48 hoursaccording to clinical urgency.These frameworks not only standardize decision-making but also streamline communication among multidisciplinary teams, enhancing operational efficiency and patient outcomes.1,4,5 Regarding patient security and management tools in health services, the safety huddle is a daily multi-professional meeting in healthcare, which directs resource allocation by addressing daily demands and risks.A review of 158 studies showed positive impacts of performing safety huddles on team processes (67.7 %), including efficiency and communication (64.4 %), situational awareness (44.6 %), and team satisfaction (29.7 %).Approximately 44.3 % of studies reported improved clinical outcomes, like timeliness and reduced errors (31.4 %), and adverse events (24.3 %), benefiting overall patient care (20.0 %).6 In this way, Kanban, is a visual management tool derived from the Japanese word "card", that enhances productivity by organizing workflow stages.Implemented in a Brazilian hospital, it notably reduced patient stay durations and eliminated bed availability issues.7 In response to the challenges at HC-FMUSP, a systematic approach to surgical prioritization was developed.Initially, a consensus was sought