Bed crisis and elective surgery late cancellations: An approach using the theory of constraints

Abstract

Late cancellations of scheduled elective surgery limit the ability of the surgical care service to achieve its goals. Attributes of these cancellations differ between hospitals and regions. The rate of late cancellations of elective surgery conducted in Hamad General Hospital, Doha, Qatar was found to be 13.14% which is similar to rates reported in hospitals elsewhere in the world; although elective surgery is performed six days a week from 7:00 am to 10:00 pm in our hospital. Simple and systematic analysis of these attributes typically provides limited solutions to the cancellation problem. Alternatively, the application of the theory of constraints with its five focusing steps, which analyze the system in its totality, is more likely to provide a better solution to the cancellation problem. To find the constraint, as a first focusing step, we carried out a retrospective and descriptive study using a quantitative approach combined with the Pareto Principle to find the main causes of cancellations, followed by a qualitative approach to find the main and ultimate underlying cause which pointed to the bed crisis. The remaining four focusing steps provided workable and effective solutions to reduce the cancellation rate of elective surgery.

Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction

“…Orthopedia has been pointed out by other studies as having cancellation percentages close to the ones found in this study, such as: 17.85% (27) and 18.4% (7) . Studies have indicated seasonality of surgical cancellations, such as winter months having higher rates of surgery cancellations.…”

The impact of a structured preoperative protocol on day of surgery cancellations

“…A patient's absence has been reported to be the reason for 16.8%-23% of cancellations (Gonzalez-Arevalo et al, 2009;Mesmar, Shatnawi, Faori, & Khader, 2011;Sahraoui & Elarref, 2014 According to previous studies, a multiprofessionally modified preoperative pathway did not affect cancellations (Siragusa et al, 2011).…”

“…A patient's absence has been reported to be the reason for 16.8%–23% of cancellations (Gonzalez‐Arevalo et al., ; Mesmar, Shatnawi, Faori, & Khader, ; Sahraoui & Elarref, ). The presented preoperative protocol is very patient centred, as all operative patients were contacted and carefully preoperatively prepared for the total operative pathway.…”

Audit of Cancellation of Elective Surgeries in a Teaching Hospital in South India

“…The rates and causes of cancellations are diverse and differ from one hospital to another. 3 Between 10% and 40% of booked elective operations may be cancelled before surgery takes place. 1,2,3,4,5 The most common cause of cancellations was lack of theatre time (i.e.…”

“…2,3,4,6,7 The other reasons include cancellation due to patient factors, cancellation for poorly optimized medical conditions, or cancellations due to administrative reasons. 2,3,4,6,8 An operating list may over-run because of delayed starts, slow turnover, unanticipated surgical/ anaesthetic problems or staff shortages. 9 Many of these are difficult to quantify.…”