Table 1 Patients with surgery indication (PSI) - system management principles

1

Waiting list

a) Mandatory - A patient can only have a surgical appointment if registered in the PSI system.

b) Inclusion - Registration of surgical indications in the system by residents or attending physicians.

c) Validation - Conduct verification process and prioritization carried out by the physician responsible for the specialty (coordinator or preceptor) who becomes the co-manager of the queue with the Administration.

2

Surgical Queue Management

a) Co-management - Responsibility for controlling indications rests with the person in charge of the surgical specialty. The Administration does not interfere with the technical criteria or the order of surgical indication. It is up to the Administration to monitor the indicators of each specialty, conducting periodic discussions for necessary adjustments to guarantee the feasibility of the inserted demands.

b) Monitoring indicators - Each specialty has access to its management level (patients indicated by the specialty), with information relevant to the indication date, the validity of the preoperative evaluation, etc. This mitigates comparisons or misuse of sensitive data across specialties. Based on the indicators, the validating physician can reposition the patient in the queue, advancing or delaying as necessary. Management has an overview and a view of each specialty for decision-making.

c) Traceability - The system documents every change made to the list. There is space to insert observations regarding the patient’s condition or logistical conditions (material availability, for example) that justify the change. If the patient has the indication removed, one should document the reason.

d) Administrative use for offer management - Although the Administration does not interfere in the management of the queue from a technical point of view (pertinence of the indication and prioritization criteria), it is co-manager of the queue by guaranteeing resources that make it possible to carry out what was scheduled and by using the median waiting time for each specialty to offer vacancies to the SUS manager, managing the external demand. As a general rule, if the specialty has more than three times its available surgical capacity already scheduled for the next six months, the offer is suspended.