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

Abstract

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.

Magnitude and Factors Associated with Elective Surgery Cancellation

“…Elective surgery cancelation is one of the health care quality problems in numerous hospitals in the world especially in developing countries where scheduled patients for surgery are not operated on the scheduled date which harms patients and wastes resources leading to increased healthcare costs where most cancelations are due to preventable causes. It usually decreases patient satisfaction which is one objective of any healthcare system and reports showed the cancelation rate ranges from 1% to 23% [4][5][6][7][8][9][10].…”

“…A wide range of cancellation rates from 1% to 40% was reported in the literature depending on the study design, types of hospitals and their level and capacity, how cancelation is defined, types of patients and the medical specialties. Our data collection was prospective one on specially designed data collection sheets which were recorded daily and checked weekly by the principal investigator, which minimized the underscoring of cancellation [2,4,5,11,13,22,[34][35][36][37][38][39].…”

Improving patient care and enhancing surgical efficiency: strategies to reduce same‐day surgical cancellations

“…First, as the authors acknowledge, it is a single-centre study focused on ambulatory otorhinolaryngology surgical patients. The root causes of same-day surgical cancellations vary widely across hospital types and patient populations [8,9], ambulatory vs. inpatient surgery [10] and surgical subspecialties [11]; thus, the success of this intervention may not apply to other settings. Second, the study evaluated the effect of an intervention relative to a standard that did not necessarily include anaesthetist-directed medical evaluation before the day of surgery.…”