Reducing last-minute cancellations of elective urological surgery—effectiveness of specialist nurse preoperative assessment

Abstract

Background Last-minute cancellations in urological surgery are a global issue resulting in wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections (UTIs) are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective, urological surgery as part of our elective recovery plan following the COVID-19 pandemic. Methods A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of “lead-in” antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimised, and vacant slots were backfilled. A new guideline was created to improve timing and structure of the generic preassessment. Results Between 01/01/21 and 30/06/21, a mean of 40 cases were booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 01/07/21, cancellations fell to 4/124 (3%) for the month. On reaudit there was a sustained and statistically significant reduction in cancellation rates: between 01/07/21 and 31/12/21 cancellations averaged 4.2/97.5 (4.3%, p<0.001). Between 2 and 9 (2-16%) patients each month were started on antibiotics, while another 0 to 2 (0-2%) were contacted for other reasons. Conclusion The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.

Predictors of same day cancellation of elective surgery

“…To date, the majority of research related to cancellation of surgery has focused on reasons for cancellation (Ezike et al 2011, Kumar & Gandhi 2012, Pohlman et al 2012, Rymaruk 2011, Smith et al 2014). Reported reasons for cancellations are highly variable across studies; however, commonly reported reasons include clinical issues such as incomplete medical evaluations, lack of medical fitness for surgery, and administrative/operational issues such as lack of financial clearance, and shortcomings in operating room or inpatient bed availability (Kaddoum et al 2016, Matzek et al 2020, Rymaruk 2011, Scheenstra et al 2021, Spazzapan et al 2023). Up to 80% of cancellations have been described as potentially avoidable (Rymaruk 2011), suggesting that interventions aimed at reducing cancellations are needed to improve operational efficiency and the patient experience (Hovlid et al 2012).…”