The NCEPOD Classification of Intervention
This classification came into effect in December 2004, and replaced the
Emergency, Urgent, Scheduled and Elective previously used by NCEPOD
IMMEDIATE – Immediate life, limb or organ-saving intervention – resuscitation simultaneous with intervention. Normally within minutes of decision to operate.
- Other e.g. limb or organ saving
EXPEDITED – Patient requiring early treatment where the condition is not an immediate threat to life, limb or organ survival. Normally within days of decision to operate.
ELECTIVE – Intervention planned or booked in advance of routine admission to hospital. Timing to suit patient, hospital and staff.
Whilst it is recognised that additional categories or sub-categories could be defined it is important that the classification remains as simple as possible to use.
Practical application of the classification
The reason for allocating such a classification to each case is to define the urgency of the patient’s intervention to:
- inform clinicians and managers responsible for preparing procedure lists and allocating theatres ‘on the day’ (day to day communications)
- check that patients are operated on within the time frame appropriate for their condition (patient experience)
- check that medical staff are operating out-of-hours only when it is appropriate (clinical governance)
- review the allocation of types of patient to types of theatre session (split into ‘daytime’ and ‘out-of-hours’) in order to take appropriate corrective action within the current organisation of surgical/radiological/cardiological services and to aid further development of these services (organisation and planning).
NCEPOD recommends that the consultant who will perform the intervention should assign the category. This should be done at the time of the decision to operate and when the theatre is booked. To be a useful tool to assist in the organisation of ‘emergency’ lists the correct classification needs to be supplied to the theatre co-ordinator when the patient is booked so an appropriate priority can be assigned to the case. The classification should be recorded in both the Theatre Management System and in the patient’s casenotes.
In the practical allocation of the category to each intervention, it is recognised that the same operation could be undertaken on patients falling into all four of the categories. Therefore it is not possible to group operations within a category to make it easy for allocation. For example:
- Immediate – for life threatening GI bleeding
- Urgent – for perforated large bowel
- Expedited – developing large bowel obstruction
- Elective – resection for non-obstructing carcinoma
- Immediate – for life-threatening traumatic bleeding
- Urgent – for on-going bleeding post-splenic injury
- Elective – for malignant or haematological disease
|Code||Category||Description||Target time to theatre||Expected location||Example Scenarios||Typical procedures|
|1||Immediate||Immediate (A) lifesaving or (B) limb or organ-saving intervention. Resuscitation simultaneous with surgical treatment.||Within minutes of decision to operate||Next available operating theatre – “break-in” to existing lists if required||
|2||Urgent||Acute onset or deterioration of conditions that threaten life, limb or organ survival; fixation of fractures; relief of distressing symptoms.||Within hours of decision to operate and normally once resuscitation completed||Day time “emergency” list or Out-of-hours emergency theatre (including at night)||
|3||Expedited||Stable patient requiring early intervention for a condition that is not an immediate threat to life, limb or organ survival||Within days of decision to operate||Elective list which has “spare” capacity or Day time “emergency” list (not at night)||
|4||Elective||Surgical procedure planned or booked in advance of routine admission to hospital||Planned||Elective theatre list booked & planned prior to admission||