Causes for cancellation of elective surgical procedures in a Spanish general hospital

González-Arévalo, A.; Gómez-Arnau, J; DelaCruz, F. J.; Marzal, J. M.; Ramirez, Sylvester G.; Corral, E. M.; García-del-Valle, Santiago

doi:10.1111/j.1365-2044.2008.05852.x

Cited by 80 publications

(91 citation statements)

References 24 publications

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“…12 After a previous successful effort at CCHMC to reduce staff overtime costs by improving on-time day start and finish times, 13 DoSC was selected for improvement. Although cancelation is more common for children than for adults, 14 few studies describe the problem. [15][16][17][18][19] Fewer still report alleviating it.…”

Section: Figurementioning

confidence: 99%

Reducing Cancelations on the Day of Scheduled Surgery at a Children’s Hospital

et al. 2015

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BACKGROUND AND OBJECTIVES: Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation.METHODS: Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and textmessage reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. RESULTS:Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites.CONCLUSIONS: By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization.Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time but is frequent in children's hospitals. 1 Families suffer inconvenience, emotional distress, and financial cost. 2 Reducing DoSC therefore improves OR utilization and also reduces impact on families. Likewise, rescheduling in advance, where appropriate, facilitates reshuffling of the operative list and accommodation of add-on cases and minimizes disruption to family life. Among the dimensions of health care quality enumerated by the Institute of Medicine, family-centeredness, efficiency, and timeliness are all impacted. 3

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Section: Figurementioning

confidence: 99%

Reducing Cancelations on the Day of Scheduled Surgery at a Children’s Hospital

et al. 2015

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“…Ó 2011 by American Society of PeriAnesthesia Nurses SURGICAL CANCELLATIONS CAUSE distress and inconvenience to families, [1][2][3][4] interfere with operating room (OR) efficiency, 1,5 and add to the overall cost of care delivery. 1,2,6 Studies show that preoperative assessment clinic (POAC) evaluation of patients before elective surgery is effective in decreasing OR cancellations.…”

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confidence: 99%

“…1,2,6 Studies show that preoperative assessment clinic (POAC) evaluation of patients before elective surgery is effective in decreasing OR cancellations. 3,[6][7][8][9][10] There is little in the literature relating to pediatric elective surgery cancellations 2,5,9 or the role of nursing in the prevention of cancellations. 10,11 Most studies reviewed originated outside the United States [1][2][3][4][5]9,10 and were focused on dayof-surgery (DOS) cancellations, with the exception of two studies that also examined the time period between the preoperative evaluation and the DOS.…”

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confidence: 99%

Surgical Cancellations: A Review of Elective Surgery Cancellations in a Tertiary Care Pediatric Institution

Boudreau¹,

Gibson²

2011

Journal of PeriAnesthesia Nursing

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“…Unexpected surgical cancellations are not uncommon, decrease patient satisfaction, waste medical resources, and undermine the morale of medical personnel [1][2][3][4]. Before seeking a strategy to reduce case cancellation rate, many medical providers and institutes investigate the cancellation rate and understand cancellation reasons.…”

Section: Introductionmentioning

confidence: 99%

“…Before seeking a strategy to reduce case cancellation rate, many medical providers and institutes investigate the cancellation rate and understand cancellation reasons. Due to a lack of standard case cancellation definition, and using different study methods [1][2][3][4][5], studies in the US have reported cancellation rates from as low as 0.21% [6] to as high as 26% [7]. Cancellation reasons also vary across studies including medical condition changes, patient no show, and scheduling issues.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Xue

Yan

Barnett

et al. 2013

J Anesthe Clinic Res

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Background: Unexpected surgical cancellation is common and can have significant adverse effects. Cancellation rates vary because of a lack of a standard definition, different patient populations and study methodology. We hypothesized that case cancellation has a different pattern in a dedicated ambulatory surgical center compared to a general operating room (OR) setting in a large academic center without an anesthesia preoperative evaluation center necessitating evaluation by the various surgeons.Methods: Elective cases in general OR and in the ambulatory surgical center were included in this study. Elective cases are defined as the non-emergent cases scheduled before 8:00 am on the day of surgery. A cancelled case was defined as a scheduled procedure which is not performed on the scheduled procedure day. Case cancellation was monitored in real time using an electronic patient flow system (Navicare). As soon as the case is cancelled, the reason for the cancellation was obtained from the surgeon, the anesthesiologist, the OR coordinated nurses and/or the floor nurse. In the day surgical center, the cancelled cases were followed to determine whether/when they were rescheduled.Results: 4261 elective cases were included in this investigation, including 2751 cases in the general OR and 1510 cases in the ambulatory surgical center. A total of 283 cases (6.6%) were cancelled which include 206 cases from the general OR and 77 from the ambulatory surgical center. The cancellation rate in the general OR was 7.5%, among which inpatients have the highest cancellation rate of 18.1%, followed by outpatients at 4.6%, and same day admission at the lowest cancellation rate of 2.0%.The top 3 reasons for cancellation in general OR werein adequate preoperative preparation 29.4 ± 4.5%, medical condition change 28.5 ± 10.2%; and scheduling issue 20.2 ± 7.1%. Most (59.2 ± 8.9%) of the cancellations was considered preventable, 12.3 ± 5.9% was considered potentially preventable, and 28.5 ± 10.2% were not preventable (such as patient condition changes). The cancellation rate in the ambulatory surgical center was 5.1%. The major reason for cancellation was patient no show 75.8 ± 5.2 %, 61% of those no show patients were rescheduled and the mean delay in surgery was 18 days (range from 1 day to 84 days). Conclusions:Case cancellation is not un-common in a large academic center without a preoperative evaluation clinic. The dynamics of case cancellation are different in an ambulatory surgical center as compared to the general OR. Inpatients have the highest cancellation rate associated with inadequate preoperative preparation and scheduling, this should be preventable via adopting proper systems of evaluation and preparation. Most of the case cancellations in the ambulatory surgical center are from patient no show, suggesting that administrative strategies to reduce this issue should be implemented. The patients admitted on the same day of surgery had the lowest cancellation rate requiring minimal intervention.

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Causes for cancellation of elective surgical procedures in a Spanish general hospital

Cited by 80 publications

References 24 publications

Reducing Cancelations on the Day of Scheduled Surgery at a Children’s Hospital

Reducing Cancelations on the Day of Scheduled Surgery at a Children’s Hospital

Surgical Cancellations: A Review of Elective Surgery Cancellations in a Tertiary Care Pediatric Institution

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

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