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Serrato P, Msosa V, Kondwani J, Nkhumbwah M, Brault MA, Heckmann R, Weiner S, Sion M, Mulima G. Perioperative Process Mapping to Identify Inefficiencies at a Tertiary Hospital in Malawi. J Surg Res 2024; 302:329-338. [PMID: 39126874 DOI: 10.1016/j.jss.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/07/2024] [Accepted: 07/03/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Same-day surgical case cancellation consumes resources, disrupts patient care, and has a global prevalence of 18%. A retrospective analysis found that 44% of scheduled elective surgeries were canceled at a public tertiary hospital in Lilongwe, Malawi. To better characterize these cancellations, this study defines a process map for surgical case completion and investigates hospital staff and patient perspectives on contributing factors and burdens of cancellation. METHODS We conducted participatory process mapping and in-depth interviews with hospital staff (n = 23) and patients (n = 10) to detail perioperative processes and perspectives on cancellations. We used purposive sampling to recruit staff by hospital role and patients whose surgery had been canceled. Interviews were audio-recorded, translated, and transcribed for process mapping accuracy and thematic analysis using the constant comparative method and NVivo software. RESULTS Staff delineated specific steps of the perioperative process, generating a process map that identifies inefficiencies and opportunities for intervention. Hospital staff described unavoidable causes of case cancellation, such as unreliable water supply and material shortages. Modifiable causes linked to wasted time and resources were also evident, such as chronic tardiness, communication barriers, and inadequate preoperative assessment. Thematic analysis of perceived impacts of cancellation revealed compromised provider-patient relationships, communication breakdown, and emotional distress. Staff and patients expressed frustration, embarrassment, fear, and demoralization when planned surgeries were canceled. CONCLUSIONS We demonstrate the use of process mapping as a tool to identify implementation targets for reducing case cancellation rates. Hospital systems can adapt this approach to address surgical case cancellation in their specific setting.
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Affiliation(s)
- Paul Serrato
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Vanessa Msosa
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jephta Kondwani
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mwai Nkhumbwah
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Marie A Brault
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut; Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, Texas
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sally Weiner
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Melanie Sion
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
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Osebo C, Razek T, Grushka J, Deckelbaum D, Khwaja K, Munthali V, Boniface R. Digitizing operating theater data in resource-limited settings: Understanding surgical care delivery post-implementation at Tanzanian referral hospital. World J Surg 2024; 48:1873-1882. [PMID: 38850082 DOI: 10.1002/wjs.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Digitizing surgical data infrastructure is critical for policymakers to make informed decisions. The implementation of the first web-based operating theater (OT) recordings at Muhimbili Orthopedic Institute (MOI) represents significant advancements in data management for Tanzania. This study aims to share post-platform implementation outcomes, challenges, and insights gained offering guidance to settings facing similar data repository challenges. METHODS In July 2023, after training clinicians, the platform was deployed at MOI operating theaters (OTs) to facilitate prospective data entry following procedures, ensuring timely updates of perioperative outcomes. Semi-structured interviews were conducted with key stakeholders to gather insights into the platform's functionality and efficient data management systems. We presented data from August 2023 to February 2024 along with platform insights. RESULTS Over 4449 procedures were conducted, comprising 1321 emergencies and 3128 electives, with orthopedics/trauma accounting for the majority (3606). Trauma-related emergencies (921) predominate among interventions. General anesthesia was prevalent; 60.56% in emergencies and 44.51% in electives. Orthopedics/trauma utilized 90.91% of assigned operating days in electives, while neurosurgery utilized 93.39% (p < 0.011). The cancellation rate was 7.5%, primarily due to emergency interferences (32%). Of procedures, 96.76% were discharged, while 2.81% died. Challenges encountered during platform implementation included securing local support, integrating technology, and navigating administrative adjustments. Lessons learned emphasized continuous communication for stakeholder buy-in and training for platform familiarity. CONCLUSION The web-based OT recordings at MOI succeeded with local support and showed promise for wider scalability. To ensure sustainability, ongoing follow-up, monitoring of platform functionality, local funding establishment, and strengthening global partnerships are recommended.
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Affiliation(s)
- Cherinet Osebo
- Department of Surgery, McGill University Health Centre, Centre for Global Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Tarek Razek
- Department of Surgery, McGill University Health Centre, Centre for Global Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jeremy Grushka
- Department of Surgery, McGill University Health Centre, Centre for Global Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Dan Deckelbaum
- Department of Surgery, McGill University Health Centre, Centre for Global Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Kosar Khwaja
- Department of Surgery, McGill University Health Centre, Centre for Global Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Victoria Munthali
- Department of Orthopedics, Muhimbili Orthopedics Institute, Injury Control Centre, Dar es Salaam, Tanzania
| | - Respicious Boniface
- Department of Orthopedics, Muhimbili Orthopedics Institute, Injury Control Centre, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Dixit AA, Sun EC. Improving patient care and enhancing surgical efficiency: strategies to reduce same-day surgical cancellations. Anaesthesia 2024; 79:573-575. [PMID: 38489835 PMCID: PMC11087192 DOI: 10.1111/anae.16282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Affiliation(s)
- A. A. Dixit
- Postdoctoral Scholar, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E. C. Sun
- Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Yu G, Michalak S, Mishra K, Yu M, Pan C. Trends of Ophthalmic Surgery Cancellations at a County Hospital Before and During COVID-19: A 10-Year Retrospective Study. Semin Ophthalmol 2024; 39:305-311. [PMID: 38073109 DOI: 10.1080/08820538.2023.2293032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Despite several publications on ophthalmic surgical cancellations discussing preventative causes in academic institutions, there remains a paucity of similar studies for safety-net hospitals. This study analyzed cancellation rates at a county hospital over a 10-year period. METHODS This retrospective, open cohort study investigated a total of 11,350 surgeries scheduled at a tertiary-level county hospital between January 1, 2012 and December 31, 2021. Surgical cancellation reasons were collected from chart review and categorized into eight groups to allow for analyses. Cancellation rates were then calculated per year and per subspecialty. The primary statistical analyses were paired, 2-tailed t test and χ2 test. RESULTS The most common reason for cancellation overall was institution-related (1065 surgeries), which was also the most common reason per year from 2012 to 2019 (range: 37.4% - 60.6%). In 2020, during COVID-19 stay-at-home mandates, the most common reason became COVID-related rescheduling, and in 2021, it was patient-driven. The cancellation rate in 2020 was significantly higher than 2019 (+9.27%,95% CI:4.96%-13.6%,p = .05), and significantly lower from 2021 to 2020 (-22.8%,95% CI:-26.8%-(-)18.7%,p = .001). Pediatric surgery had the highest cancellation rate overall (36.4%), but oculoplastics had the highest cancellation rate in 2020 (48.9%). CONCLUSION The most common reason for cancellation over the 10-year period was institution-related, in contrast to other publications based in academic centers. The study also had a higher cancellation rate than previously reported, again suggesting the difference between county and academic centers. The COVID-19 pandemic had a significant impact on cancellations, even after the COVID-19 stay-at-home orders were eased.
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Affiliation(s)
- Gina Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Suzanne Michalak
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Kapil Mishra
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Michael Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Carolyn Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
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Hanson J, Hui M, Strawbridge JC, Chatterjee S, Goodyear K, Giaconi JA, Tsui I. High Rates of Eye Surgery Cancellation in Veterans Related to Mental Health. Mil Med 2024:usae230. [PMID: 38687601 DOI: 10.1093/milmed/usae230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Approximately 9 million veterans receive health care at the Veterans Health Administration, many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such as posttraumatic stress disorder or depression may create challenges in using health care services, such as surgery. The aim of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. MATERIALS AND METHODS This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture were queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and comorbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation. RESULTS A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n = 270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (odds ratio [OR], 2.53, P = .04). For retina surgery, patients with posttraumatic stress disorder were more likely to have cancellation (OR, 4.23, P = .01). Glaucoma patients with anxiety (OR, 5.78, P = .05) and depression (OR, 4.05, P = .04) were more likely to have cancellation. CONCLUSIONS There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and comorbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients before surgery.
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Affiliation(s)
- Justin Hanson
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Maggie Hui
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Jason C Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Sayan Chatterjee
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - Kendall Goodyear
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
| | - JoAnn A Giaconi
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
- Division of Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 , USA
| | - Irena Tsui
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, CA 90095, USA
- Division of Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 , USA
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Reuter S, Schmalfeldt B, Haas SA, Zapf A, Cevirme S, Prieske K, Wölber L, Müller V, Zöllner C, Jaeger A. Impact of Introducing a PACU24 Concept on the Perioperative Outcome of Patients with Advanced Ovarian Cancer Treated with Cytoreductive Surgery. Geburtshilfe Frauenheilkd 2023; 83:1022-1030. [PMID: 37588253 PMCID: PMC10427201 DOI: 10.1055/a-2055-9349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/15/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort. Methods A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and after (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary. Results The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p = 0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p < 0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU). Summary Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.
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Affiliation(s)
- Susanne Reuter
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian A. Haas
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Antonia Zapf
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sinan Cevirme
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Hage FG, Einstein AJ, Ananthasubramaniam K, Bourque JM, Case J, DePuey EG, Hendel RC, Henzlova MJ, Shah NR, Abbott BG, Al Jaroudi W, Better N, Doukky R, Duvall WL, Malhotra S, Pagnanelli R, Peix A, Reyes E, Saeed IM, Sanghani RM, Slomka PJ, Thompson RC, Veeranna V, Williams KA, Winchester DE. Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement. J Nucl Cardiol 2023; 30:864-907. [PMID: 36607538 DOI: 10.1007/s12350-022-03162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Fadi G Hage
- Section of Cardiology, Birmingham VA Medical Center, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 446 GSB, 520 19Th Street South, Birmingham, AL, 35294, USA.
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - E Gordon DePuey
- Mount Sinai Morningside Hospital, New York, NY, USA
- Bay Ridge Medical Imaging, Brooklyn, NY, USA
| | - Robert C Hendel
- Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Nishant R Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wael Al Jaroudi
- Division of Cardiovascular Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nathan Better
- Department of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ibrahim M Saeed
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
- University of Missouri, Kansas City, MO, USA
| | - Rupa M Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vikas Veeranna
- Division of Cardiology, Department of Medicine, New England Heart and Vascular Institute, Manchester, NH, USA
| | - Kim A Williams
- Department of Medicine, University of Louisville Department of Medicine, Louisville, KY, USA
| | - David E Winchester
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Wadhwani N, Wang R, Chen H. Audit of case cancellations on the day of surgery at a single tertiary healthcare institution. Am J Surg 2023. [PMID: 36863944 DOI: 10.1016/j.amjsurg.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Nikita Wadhwani
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Ave South, BDB Suite 202, Birmingham, AL, 35233, USA.
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Ave South, BDB Suite 202, Birmingham, AL, 35233, USA.
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Ave South, BDB Suite 202, Birmingham, AL, 35233, USA.
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Zafar JE, Chan KT, Ryder LJ, Duffy AJ, Dai F, Carr ZJ, Charchaflieh JG. Information Technology-Enhanced Telehealth Consultations Reduce Preoperative Evaluation Center Visits in a Bariatric Surgery Population. Healthcare (Basel) 2023; 11:healthcare11030309. [PMID: 36766884 PMCID: PMC9914614 DOI: 10.3390/healthcare11030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
Background: Preoperative patient evaluation and optimization in a preoperative evaluation center (PEC) has been shown to improve operating room (OR) efficiency and patient care. However, performing preoperative evaluation on all patients scheduled for surgery or procedure would be time- and resource-consuming. Therefore, appropriate patient selection for evaluation at PECs is one aspect of improving PEC efficiency. In this study, we evaluate the effect of an enhanced preoperative evaluation process (PEP), utilizing a nursing triage phone call and information technology (IT) optimizations, on PEC efficiency and the quality of care in bariatric surgery patients. We hypothesized that, compared to a traditional PEP, the enhanced PEP would improve PEC efficiency without a negative impact on quality. Methods: The study was a retrospective cohort analysis of 1550 patients from January 2014 to March 2017 at a large, tertiary care academic health system. The study was a before/after comparison that compared the enhanced PEP model to the traditional PEP model. The primary outcome was the efficiency of the PEC, which was measured by the reduction of in-person patient visits at the PEC. The secondary outcome was the quality of care, which was measured by delays, cancellations, and the need for additional testing on the day of surgery (DOS). Results: The enhanced PEP improved the primary outcome of efficiency, as evident by an 80% decrease in in-person patient visits to the PEC. There was no reduction in the secondary outcome of the quality of care as measured by delays, cancellations, or the need for additional testing on the DOS. The implementation of the enhanced PEP did not result in increased costs or resource utilization. Conclusions: The enhanced PEP in a multi-disciplinary preoperative process can improve the efficiency of PEC for bariatric surgery patients without any decrease in the quality of care. The enhanced PEP process can be implemented without an increase in resource utilization and can be particularly useful during the COVID-19 pandemic.
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Affiliation(s)
- Jill E. Zafar
- Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA
| | - Kathleen T. Chan
- Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA
| | | | - Andrew J. Duffy
- Yale School of Medicine, Department of General Surgery, Division of Yale Bariatric/Gastrointestinal Surgery, Temple Medical Center, New Haven, CT 06510, USA
| | - Feng Dai
- Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA
| | - Zyad J. Carr
- Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA
| | - Jean G. Charchaflieh
- Yale School of Medicine, Department of Anesthesiology, New Haven, CT 06510, USA
- Correspondence: ; Tel.: +1-203-785-2802; Fax: +1-203-785-6664
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Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments. J Am Acad Orthop Surg 2022; 30:1131-1139. [PMID: 36400060 DOI: 10.5435/jaaos-d-22-00456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery. METHODS A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05. RESULTS A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036). DISCUSSION Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.
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Wongtangman K, Azimaraghi O, Freda J, Ganz-Lord F, Shamamian P, Bastien A, Mirhaji P, Himes CP, Rupp S, Green-Lorenzen S, Smith RV, Medrano EM, Anand P, Rego S, Velji S, Eikermann M. Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures. J Clin Anesth 2022; 83:110987. [PMID: 36308990 DOI: 10.1016/j.jclinane.2022.110987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Avoidable case cancellations within 24 h reduce operating room (OR) efficiency, add unnecessary costs, and may have physical and emotional consequences for patients and their families. We developed and validated a prediction tool that can be used to guide same day case cancellation reduction initiatives. DESIGN Retrospective hospital registry study. SETTING University-affiliated hospitals network (NY, USA). PATIENTS 246,612 (1/2016-6/2021) and 58,662 (7/2021-6/2022) scheduled elective procedures were included in the development and validation cohort. MEASUREMENTS Case cancellation within 24 h was defined as cancelling a surgical procedure within 24 h of the scheduled date and time. Our candidate predictors were defined a priori and included patient-, procedural-, and appointment-related factors. We created a prediction tool using backward stepwise logistic regression to predict case cancellation within 24 h. The model was subsequently recalibrated and validated in a cohort of patients who were recently scheduled for surgery. MAIN RESULTS 8.6% and 8.7% scheduled procedures were cancelled within 24 h of the intended procedure in the development and validation cohort, respectively. The final weighted score contains 29 predictors. A cutoff value of 15 score points predicted a 10.3% case cancellation rate with a negative predictive value of 0.96, and a positive predictive value of 0.21. The prediction model showed good discrimination in the development and validation cohort with an area under the receiver operating characteristic curve (AUC) of 0.79 (95% confidence interval 0.79-0. 80) and an AUC of 0.73 (95% confidence interval 0.72-0.73), respectively. CONCLUSIONS We present a validated preoperative prediction tool for case cancellation within 24 h of surgery. We utilize the instrument in our institution to identify patients with high risk of case cancellation. We describe a process for recalibration such that other institutions can also use the score to guide same day case cancellation reduction initiatives.
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Affiliation(s)
- Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jeffrey Freda
- Vice President, Surgical Services, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Fran Ganz-Lord
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Peter Shamamian
- Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alexandra Bastien
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Parsa Mirhaji
- Center for Health Data Innovations, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Carina P Himes
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Rupp
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Richard V Smith
- Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Elilary Montilla Medrano
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Preeti Anand
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Simon Rego
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Salimah Velji
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
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12
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Tewfik GL, Rodriguez-Aponte C, Zhang K, Ezzat B, Suri P, Chaudhry F. Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis. Anesth Analg 2022; 135:845-854. [PMID: 35913700 DOI: 10.1213/ane.0000000000006156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many day-of-surgery cancellations are avoidable, and different strategies are used to prevent these costly adverse events. Despite these past analyses and evaluations of positive interventions, studies have not examined the final disposition of patients whose cases were canceled in this late manner. This study sought to determine whether surgical procedures canceled for medical or anesthetic reasons were ultimately rescheduled, and the time elapsed between cancellation and completion. In addition, the resolution of the underlying issue leading to cancellation was examined. METHODS Two years of surgical case data were reviewed in the electronic health record to isolate all procedures canceled on the intended operative date. These cases were then filtered by the documented reason for cancellation into 2 categories: 1 for cases related to medical or anesthetic care and 1 for unrelated cases. Medical- or anesthetic-related cases were further categorized to better elucidate the underlying reason for cancellation. Cases were then traced to determine if and when the procedure was ultimately completed. If a case was rescheduled, the record was reviewed to determine whether the underlying reason for cancellation was resolved. RESULTS A total of 4472 cases were canceled in the study period with only 20% associated with medical or anesthetic causes. Of these, 72% were rescheduled and 83% of all rescheduled cases resolved the underlying issue before the rescheduled procedure. Nearly half of all cases (47.8%) canceled on the day of surgery for reasons linked to medical and/or anesthetic care were due to acute conditions. CONCLUSIONS Nearly a fifth of cases that are canceled on the date of surgery are never rescheduled and, if they are rescheduled, the delay can be substantial. Although the majority of patients whose procedure are canceled for reasons related to medical or anesthetic care have resolved the underlying issue that led to initial postponement, a significant portion of patients have no change in their status before the ultimate completion of their surgical procedure.
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Affiliation(s)
- George L Tewfik
- From the Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey
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13
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Das D, Hasija S, Chauhan S, Devagourou V, Sharma AK, Khan MA. Is menstruation a valid reason to postpone cardiac surgery? Ann Card Anaesth 2022; 25:311-317. [PMID: 35799559 PMCID: PMC9387632 DOI: 10.4103/aca.aca_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.
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Affiliation(s)
- Devishree Das
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Suruchi Hasija
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Aparna K Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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14
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Nadimi AE, Spierling Bagsic SR, Prosser M, Greenway HT. Reasons for Mohs Micrographic Surgery Cancellation: A Retrospective 1-Year Analysis in a Tertiary Care Clinic Before the COVID-19 Pandemic. Dermatol Surg 2022; 48:252-253. [PMID: 34889216 DOI: 10.1097/dss.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ardeshir Edward Nadimi
- Scripps Green Hospital, Bighorn Mohs Surgery and Dermatology Center, San Diego, California
| | | | - Megan Prosser
- Bighorn Mohs Surgery and Dermatology Center, San Diego, California
| | - Hubert T Greenway
- Scripps Green Hospital, Bighorn Mohs Surgery and Dermatology Center, San Diego, California
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15
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Pattnaik S, Dixit SK, Bishnoi V. The Burden of Surgical Cancellations: A Quality Improvement Study on the Importance of Preoperative Assessment. Cureus 2022; 14:e21731. [PMID: 35251804 PMCID: PMC8887625 DOI: 10.7759/cureus.21731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/05/2022] Open
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16
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Scheenstra B, Princée AMA, Imkamp MSV, Kietselaer B, Ganushchak YM, van’t Hof AWJ, Maessen JG. Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre. Eur J Cardiothorac Surg 2021; 61:225-232. [PMID: 34021310 PMCID: PMC8715847 DOI: 10.1093/ejcts/ezab246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/09/2021] [Accepted: 04/16/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Unanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes. METHODS Patients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation. RESULTS A total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30-4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant. CONCLUSIONS Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.
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Affiliation(s)
- Bart Scheenstra
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Anouk M A Princée
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Maike S V Imkamp
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Yuri M Ganushchak
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arnoud W J van’t Hof
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
- Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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17
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Aldawoodi NN, Muncey AR, Serdiuk AA, Miller MD, Hanna MM, Laborde JM, Garcia Getting RE. A Retrospective Analysis of Patients Undergoing Telemedicine Evaluation in the PreAnesthesia Testing Clinic at H. Lee Moffitt Cancer Center. Cancer Control 2021; 28:10732748211044347. [PMID: 34644199 PMCID: PMC8521730 DOI: 10.1177/10732748211044347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Telemedicine for preanesthesia evaluation can decrease access disparities by minimizing commuting, time off work, and lifestyle disruptions from frequent medical visits. We report our experience with the first 120 patients undergoing telemedicine preanesthesia evaluation at Moffitt Cancer Center. Methods This is a retrospective analysis of 120 patients seen via telemedicine for preanesthesia evaluation compared with an in-person cohort meeting telemedicine criteria had it been available. Telemedicine was conducted from our clinic to a patient’s remote location using video conferencing. Clinic criteria were revised to create a tier of eligible patients based on published guidelines and anesthesiologist consensus. Results Day-of-surgery cancellation rate was 1.67% in the telemedicine versus 0% in the in-person cohort. The two telemedicine group cancellations were unrelated to medical workup, and cancellation rate between the groups was not statistically significant (P = .49). Median round trip distance and time saved by the telemedicine group was 80 miles [range 4; 1180] and 121 minutes [range 16; 1034]. Using the federal mileage rate, the median cost savings was $46 [range $2.30; 678.50] per patient. Patients were similar in gender and race in both groups (P = .23 and .75, respectively), but the in-person cohort was older and had higher American Society of Anesthesiologists physical status classification (P = .0003). Conclusions Telemedicine preanesthesia evaluation results in time, distance, and financial savings without increased day-of-surgery cancellations. This is useful in cancer patients who travel significant distances to specialty centers and have a high frequency of health care visits. American Society of Anesthesiologists Physical Status classification and age differences between cohorts indicate possible patient or provider selection bias. Randomized controlled trials will aid in further exploring this technology.
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Affiliation(s)
| | | | | | | | - Mark M Hanna
- H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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18
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Liu L, Ni Y, Beck AF, Brokamp C, Ramphul RC, Highfield LD, Kanjia MK, Pratap JN. Understanding Pediatric Surgery Cancellation: Geospatial Analysis. J Med Internet Res 2021; 23:e26231. [PMID: 34505837 PMCID: PMC8463951 DOI: 10.2196/26231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/28/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2% and 20% of the 50 million procedures performed annually in American hospitals. Up to 85% of cancellations may be amenable to the modification of patients' and families' behaviors. However, the factors underlying DoSC and the barriers experienced by families are not well understood. OBJECTIVE This study aims to conduct a geospatial analysis of patient-specific variables from electronic health records (EHRs) of Cincinnati Children's Hospital Medical Center (CCHMC) and of Texas Children's Hospital (TCH), as well as linked socioeconomic factors measured at the census tract level, to understand potential underlying contributors to disparities in DoSC rates across neighborhoods. METHODS The study population included pediatric patients who underwent scheduled surgeries at CCHMC and TCH. A 5-year data set was extracted from the CCHMC EHR, and addresses were geocoded. An equivalent set of data >5.7 years was extracted from the TCH EHR. Case-based data related to patients' health care use were aggregated at the census tract level. Community-level variables were extracted from the American Community Survey as surrogates for patients' socioeconomic and minority status as well as markers of the surrounding context. Leveraging the selected variables, we built spatial models to understand the variation in DoSC rates across census tracts. The findings were compared to those of the nonspatial regression and deep learning models. Model performance was evaluated from the root mean squared error (RMSE) using nested 10-fold cross-validation. Feature importance was evaluated by computing the increment of the RMSE when a single variable was shuffled within the data set. RESULTS Data collection yielded sets of 463 census tracts at CCHMC (DoSC rates 1.2%-12.5%) and 1024 census tracts at TCH (DoSC rates 3%-12.2%). For CCHMC, an L2-normalized generalized linear regression model achieved the best performance in predicting all-cause DoSC rate (RMSE 1.299%, 95% CI 1.21%-1.387%); however, its improvement over others was marginal. For TCH, an L2-normalized generalized linear regression model also performed best (RMSE 1.305%, 95% CI 1.257%-1.352%). All-cause DoSC rate at CCHMC was predicted most strongly by previous no show. As for community-level data, the proportion of African American inhabitants per census tract was consistently an important predictor. In the Texas area, the proportion of overcrowded households was salient to DoSC rate. CONCLUSIONS Our findings suggest that geospatial analysis offers potential for use in targeting interventions for census tracts at a higher risk of cancellation. Our study also demonstrates the importance of home location, socioeconomic disadvantage, and racial minority status on the DoSC of children's surgery. The success of future efforts to reduce cancellation may benefit from taking social, economic, and cultural issues into account.
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Affiliation(s)
- Lei Liu
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, OH, United States
| | - Yizhao Ni
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ryan C Ramphul
- Department of Government Relations and Community Benefits, Texas Children's Hospital, Houston, TX, United States
| | - Linda D Highfield
- Department of Management, Policy & Community Health, University of Texas Health Science Center School of Public Health, Houston, TX, United States
- Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center School of Public Health, Houston, TX, United States
| | - Megha Karkera Kanjia
- Department of Pediatric Anesthesiology and Pain Management, Texas Children's Hospital, Houston, TX, United States
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, United States
| | - J Nick Pratap
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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19
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Schretlen S, Hoefsmit P, Kats S, van Merode G, Maessen J, Zandbergen R. Reducing surgical cancellations: a successful application of Lean Six Sigma in healthcare. BMJ Open Qual 2021; 10:bmjoq-2021-001342. [PMID: 34462263 PMCID: PMC8407222 DOI: 10.1136/bmjoq-2021-001342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic emphasises the need to use healthcare resources efficient and effective to guarantee access to high-quality healthcare in an affordable manner. Surgical cancellations have a negative impact on these. We used the Lean Six Sigma (LSS) methodology to reduce cardiac surgical cancellations in a University Medical Center in the Netherlands, where approximately 20% of cardiac surgeries were being cancelled. METHOD A multifunctional project team used the data-driven LSS process improvement methodology and followed the 'DMAIC' improvement cycle (Define, Measure, Analyse, Improve, Control). Through all DMAIC phases, real-world data from the hospital information system supported the team during biweekly problem-solving sessions. This quality improvement study used an 'interrupted time series' study design. Data were collected between January 2014 and December 2016, covering 20 months prior and 16 months after implementation. Outcomes were number of last-minute coronary artery bypass graft cancellations, number of repeated diagnostics, referral to treatment time and patient satisfaction. Statistical process control charts visualised the change and impact over time. Students two-sample t-test was used to test statistical significance. A p<0.05 was considered as statistically significant. RESULTS Last-minute cancellations were reduced by 50% (p=0.010), repeated preoperative diagnostics (X-ray) declined by 67% (p=0.021), referral to treatment time reduced by 35% (p=0.000) and patient Net Promoter Score increased by 14% (p=0.005). CONCLUSION This study shows that LSS is an effective quality improvement approach to help healthcare organisations to deliver more safe, timely, effective, efficient, equitable and patient-centred care. Crucial success factors were the use of a structured data-driven problem-solving approach, focus on patient value and process flow, leadership support and engagement of involved healthcare professionals through the entire care pathway. Ongoing monitoring of key performance indicators is helpful in engaging the organisation to maintain continuous process improvement and sustaining long-term impact.
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Affiliation(s)
- Stijn Schretlen
- Integrated Health Solutions, Medtronic plc, Maastricht, Nederland, The Netherlands .,Heart+Vascular Centre, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Paulien Hoefsmit
- Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Suzanne Kats
- Heart+Vascular Centre, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Geofridus van Merode
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Jos Maessen
- Heart+Vascular Centre, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Reinier Zandbergen
- Heart+Vascular Centre, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
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20
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Caesar U, Karlsson L, Hamrin Senorski E, Karlsson J, Hansson-Olofsson E. Delayed and cancelled orthopaedic surgery; are there solutions to reduce the complex set of problems? A systematic literature review. Int J Clin Pract 2021; 75:e14092. [PMID: 33590942 DOI: 10.1111/ijcp.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Unexpected cancellations of, and delays to, orthopaedic surgery have adverse effects, with a negative impact on hospital performance and undesirable patient outcomes. As cancellations and delays are common, finding measures to prevent them is a matter of urgency. METHODS The present systematic review conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook. Peer-reviewed studies reporting on cancellations or delays in patients requiring emergency orthopaedic or planned orthopaedic surgery that compared care action/intervention with no action or traditional care were included. The Grading of Recommendations Assessment, Development and Evaluation used to assess the quality of evidence of the results from the included studies. The objective of the present study was systematically to search and review the literature for qualitative evidence of factors that might reduce cancellations of and delays to orthopaedic surgical procedures. RESULTS The electronic search yielded 1209 studies and eight articles were included in the performed quality assessment. The heterogeneity of the studies and the lack of calculations and statistics in the studies resulted in no meta-analysis. The result of the quality assessment indicated that the evidence ranked from low to very low across the different outcomes. The main limiting factor, which was the reason for a decrease in quality in some outcomes, was the study designs, which were non-randomised control or retrospective approach. The interventions in the included studies could help to support a reduction in the risk of cancelled and delayed orthopaedic procedures. CONCLUSION This systematic literature review has revealed important evidence to help reduce the risk of cancelled and delayed orthopaedic procedures associated with a variety of care action exposures. They include a fast-track pathway, pre-operative guidelines and telephone contact with patients prior to surgery, as well as careful consideration of additional pre-operative tests.
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Affiliation(s)
- Ulla Caesar
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Faculty of Caring Sciences Work Life & Social Welfare, Boras University, Boras, Sweden
| | - Louise Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Hansson-Olofsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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21
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Abstract
Telemedicine represents an area of rapid growth in anesthesiology. Remote preoperative evaluation is associated with high patient and physician satisfaction scores, reduced patient travel and wait times, and similar procedure cancellation rates compared with in-person clinic evaluation. Preoperative tele-evaluation has facilitated a return to normal function during the coronavirus disease 2019 (COVID-19) pandemic. Intraoperatively, remote vital sign monitoring and telecommunications technology combined with a care team model allows provision of expert care in areas experiencing a shortage of anesthesiologists. Virtual intensive care units provide overflow capability for postoperative patients, whereas patient smartphones can reduce the need for in-person evaluation.
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Affiliation(s)
- Kathryn Harter Bridges
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA.
| | - Julie Ryan McSwain
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA
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22
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Rubinger L, Gazendam A, Wood T, Yardley D, Shanthanna H, Bhandari M. Team Approach: Virtual Care in the Management of Orthopaedic Patients. JBJS Rev 2021; 9:01874474-202107000-00010. [PMID: 34270503 DOI: 10.2106/jbjs.rvw.20.00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Telemedicine and remote care administered through technology are among the fastest growing sectors in health care. The utilization and implementation of virtual-care technologies have further been accelerated with the recent COVID-19 pandemic. » Remote, technology-based patient care is not a "one-size-fits-all" solution for all medical and surgical conditions, as each condition presents unique hurdles, and no true consensus exists regarding the efficacy of telemedicine across surgical fields. » When implementing virtual care in orthopaedics, as with standard in-person care, it is important to have a well-defined team structure with a deliberate team selection process. As always, a team with a shared vision for the care they provide as well as a supportive and incentivized environment are integral for the success of the virtual-care mechanism. » Future studies should assess the impact of primarily virtual, integrated, and multidisciplinary team-based approaches and systems of care on patient outcomes, health-care expenditure, and patient satisfaction in the orthopaedic population.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Gazendam
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Wood
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Harsha Shanthanna
- Department of Anesthesia, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Evidence-Based Orthopaedics, Hamilton, Ontario, Canada
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Becker J, Huschak G, Petzold HC, Thieme V, Stehr S, Bercker S. Non-medical risk factors associated with postponing elective surgery: a prospective observational study. BMC Med Ethics 2021; 22:90. [PMID: 34256762 PMCID: PMC8275631 DOI: 10.1186/s12910-021-00660-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.
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Affiliation(s)
- Julia Becker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gerald Huschak
- Operating Room Management, University Hospital of Leipzig, Leipzig, Germany
| | - Hannes-Caspar Petzold
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.,Clinical Ethics Committee, University Hospital of Leipzig, Leipzig, Germany
| | - Volker Thieme
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sven Bercker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. .,Clinical Ethics Committee, University Hospital of Leipzig, Leipzig, Germany.
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Tran LD, Rose L, Urech T, Dalton A, Wu S, Vashi AA. Short-term Effects of Canceled Elective Procedures Due to COVID-19: Evidence From the Veterans Affairs Healthcare System. Ann Surg 2021; 274:45-49. [PMID: 33630440 PMCID: PMC8187293 DOI: 10.1097/sla.0000000000004809] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether delayed or canceled elective procedures due to COVID-19 resulted in higher rates of ED utilization and/or increased mortality. SUMMARY OF BACKGROUND DATA On March 15, 2020, the VA issued a nationwide order to temporarily pause elective cases due to COVID-19. The effects of this disruption on patient outcomes are not yet known. METHODS This retrospective cohort study used data from the VA Corporate Data Warehouse. Surgical procedures canceled due to COVID-19 in 2020 (n = 3326) were matched to similar completed procedures in 2018 (n = 151,863) and 2019 (n = 146,582). Outcome measures included 30- and 90-day VA ED use and mortality in the period following the completed or canceled procedure. We used exact matching on surgical procedure category and nearest neighbor matching on patient characteristics, procedure year, and facility. RESULTS Patients with elective surgical procedures canceled due to COVID-19 were no more likely to have an ED visit in the 30- [Difference: -4.3% pts; 95% confidence interval (CI): -0.078, -0.007] and 90 days (-0.9% pts; 95% CI: -0.068, 0.05) following the expected case date. Patients with cancellations had no difference in 30- (Difference: 0.1% pts; 95% CI: -0.008, 0.01) and 90-day (Difference: -0.4% pts; 95% CI: -0.016, 0.009) mortality rates when compared to similar patients with similar procedures that were completed in previous years. CONCLUSIONS The pause in elective surgical cases was not associated with short-term adverse outcomes in VA hospitals, suggesting appropriate surgical case triage and management. Further study will be essential to determine if the delayed cases were associated with longer-term effects.
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Affiliation(s)
- Linda Diem Tran
- Health Economics Resource Center, Department of Veterans Affairs, Menlo Park, California
- Stanford Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, California
| | - Liam Rose
- Health Economics Resource Center, Department of Veterans Affairs, Menlo Park, California
- Stanford Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, California
| | - Tracy Urech
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Aaron Dalton
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Siqi Wu
- Stanford Primary Care and Population Health, Stanford University, Stanford, California
| | - Anita A Vashi
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California
- Department of Emergency Medicine (Affiliated), Stanford University, Stanford, California
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Llanos S, Galán-Olleros M, Manrique E, Celada R, Galeote J, Marco F. Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Public Perceptions of Resuming Elective Surgery During the COVID-19 Pandemic. J Arthroplasty 2021; 36:397-402.e2. [PMID: 32807565 PMCID: PMC7369592 DOI: 10.1016/j.arth.2020.07.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/28/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Many U.S. health systems are grappling with how to safely resume elective surgery amid the COVID-19 pandemic. We used online crowdsourcing to explore public perceptions and concerns toward resuming elective surgery during the pandemic, and to determine factors associated with the preferred timing of surgery after health systems reopen. METHODS A 21-question survey was completed by 722 members of the public using Amazon Mechanical Turk. Multivariable logistic regression analysis was performed to determine factors associated with the timing of preferred surgery after health systems reopen. RESULTS Most (61%) participants were concerned with contracting COVID-19 during the surgical process, primarily during check-in and in waiting room areas, as well as through excessive interactions with staff. Overall, 57% would choose to have their surgery at a hospital over an outpatient surgery center. About 1 in 4 (27%) would feel comfortable undergoing elective surgery in the first month of health systems reopening. After multivariable adjustment, native English speaking (OR, 2.6; 95% CI, 1.04-6.4; P = .042), male sex (OR, 1.9; 95% CI, 1.3-2.7; P < .001), and Veterans Affairs insurance (OR, 4.5; 95% CI, 1.1-18.7; P = .036) were independent predictors of preferring earlier surgery. CONCLUSION Women and non-native English speakers may be more hesitant to undergo elective surgery amid the COVID-19 pandemic. Despite concerns of contagion, more than half of the public favors a hospital setting over an outpatient surgery center for their elective surgery. Concerted efforts to minimize patient congestion and unnecessary face-to-face interactions may prove most effective in reducing public anxiety and concerns over the safety of resuming elective care.
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Mehran N, Ojalvo I, Myers JS, Razeghinejad R, Lee D, Kolomeyer NN. Surgical Cancellations in Glaucoma Practice: Causes, Delays, and Effect on Patient Care and Revenue. Ophthalmol Glaucoma 2020; 4:427-432. [PMID: 33338680 DOI: 10.1016/j.ogla.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the incidence of glaucoma surgery cancellations, as well as their characteristics, underlying reasons, resultant surgical delay, and estimated lost potential reimbursement, at a tertiary eye hospital. DESIGN Retrospective observational study of planned surgical procedures of 4 glaucoma specialists at a tertiary eye center over a 2-year period (May 2017-May 2019). An additional prospective survey of patients was conducted. PARTICIPANTS Patients who canceled glaucoma surgeries. METHODS Demographics and clinical information were recorded from the electronic medical record. A brief phone survey was implemented to determine the reason for cancellation and whether the patient rescheduled. Lost reimbursement was estimated assuming Medicare reimbursement rates for each procedure based on facility fee, surgeon fee, and anesthesia fee. MAIN OUTCOME MEASURES Reasons for surgical cancellation, delay related to surgical cancellations, and annual lost reimbursement potential. RESULTS One hundred twenty-three of 1384 glaucoma surgeries (8.9%) to be performed by 4 glaucoma specialists at Wills Eye Hospital during the 2-year study period were canceled. Among those canceled, the mean age ± standard deviation (SD) of the patients was 70.3 ± 14.4 years and 51% were men. Of the cancellations, 56.9% were made within 1 day of the planned date of surgery and 96.7% were canceled within 7 days. Of the reasons for surgical cancellation, 28% were considered preventable, 50% were considered unpreventable, and 23% were categorized as "no reason given." Most of the surgeries eventually were performed-to-date (64.2%); the mean ± SD delay in surgery was 63.4 ± 68.6 days. The 3 most common preventable reasons for cancellation were lack of transportation (34%), lack of timely clearance (26%), and insurance-related issues (14%). Assuming Medicare reimbursement rates, the estimated annual lost potential reimbursement from surgical cancellations of the 4 glaucoma specialists was $208 306. CONCLUSIONS This study highlights a significant number of cancellations in a glaucoma practice, most of which occurred within 1 day of planned surgery. Minimizing preventable causes of cancellations could decrease the likelihood of surgical delays as well as lost reimbursement. Further comparison with patients who successfully underwent surgery performed without delay may identify predictive factors or interventions that could decrease the number of surgical cancellations.
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Affiliation(s)
- Nikki Mehran
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Israel Ojalvo
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Natasha Nayak Kolomeyer
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania.
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Birhanu Y, Endalamaw A, Adu A. Root causes of elective surgical case cancellation in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:46. [PMID: 33298136 PMCID: PMC7727239 DOI: 10.1186/s13037-020-00271-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. In Ethiopia, prevalence and root causes for elective surgical case cancellation varies from time to time in different settings. This systematic review and meta-analysis aimed to find the pooled prevalence and root causes for elective surgical case cancellation in Ethiopia. METHODS The databases for the search were Web of Science, PubMed, and Google Scholar. The last literature search was performed on February 8, 2020. To assess publication bias Egger's regression analysis was applied. The pooled estimation was estimated using random-effects model meta-analysis. Subgroup analysis was also done based on the root causes of surgical case cancellation. RESULTS This meta-analysis included a total of 5 studies with 5591 study participants. The pooled prevalence of elective surgical case cancellation was 21.41% (95% CI: 12.75 to 30.06%). Administration-related reason (34.50%) was the most common identified root cause, followed by surgeon (25.29%), medical (13.90%), and patient-related reasons (13.34%). CONCLUSION The prevalence of elective surgical case cancellation was considerable. The most common root cause for elective surgical case cancellation was administration-related reasons, followed by the surgeon, medical and patient-related reasons. The causes for the surgical cancellations are potentially preventable. Thus, efforts should be made to prevent unnecessary cancellations through careful planning.
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Affiliation(s)
- Yeneabat Birhanu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aynalem Adu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abdalla Y. Value based healthcare: Maximizing efficacy and managing risk with spinal implant technology. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Llanos S, Galán-Olleros M, Manrique E, Celada R, Galeote JE, Marco F. Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:75-84. [PMID: 33177010 DOI: 10.1016/j.recot.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). MATERIAL AND METHODS Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. RESULTS We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. CONCLUSIONS The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.
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Affiliation(s)
- S Llanos
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - M Galán-Olleros
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - E Manrique
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - R Celada
- Servicio de Admisión y Documentación clínica. Hospital Clínico San Carlos, Madrid, España
| | - J E Galeote
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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Ballon-Landa E, Clavijo R, Gross M, Tapscott A, Ramasamy R, Bowen A, Freedman S, Wierschem M, Welliver C, Simoncini F, Duboy A, Simhan J, Bullock A, Perito P, Hsieh TC. A Novel Video-Based Patient Education Program to Reduce Penile Prosthetic Surgery Cancellations. Am J Mens Health 2020; 13:1557988319893568. [PMID: 31810419 PMCID: PMC6900623 DOI: 10.1177/1557988319893568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Penile prosthetic surgery is an effective treatment for men with erectile
dysfunction. Cancellation of surgery is disruptive and costly to patients,
physicians, and the healthcare system. This pilot study sought to analyze
surgery cancellations and implement a video-based patient education program to
decrease surgery noncompletion. Baseline penile prosthetic surgery completion, rescheduling, and cancellation
rates among consecutively scheduled surgeries were determined using a national
cohort. Selected prosthetic surgeons then implemented Vidscrip, a video-based
patient education program. Prerecorded videos were delivered via text message 14
days, 7 days, and 1 day preoperatively, as well as 1 day postoperatively.
Subsequent analysis determined noncompletion rates, reasons for noncompletion,
surgeon volume, and video utilization. Two-hundred twenty-six surgeries were scheduled in the baseline cohort; 141 were
completed, and 85 were rescheduled or canceled. Among the intervention cohort,
290 patients completed, 7 rescheduled, and 37 canceled surgery. After program
implementation, the surgery noncompletion rate was reduced compared to baseline
(13.2% vs. 37.6%, p < .05), corresponding to a number needed
to treat of 4.1. When stratified by surgeon volume, there was no difference in
noncompletion rate (>20 cases vs. ≤20 cases: 8.20% vs. 32.0%,
p = .35). Video utilization was widely variable among
practices (median viewing time 58.6 min, IQR 5.09–113). Penile prosthetic surgery is frequently rescheduled or canceled. Implementing a
video-based patient education program reduces surgery noncompletion, improving
efficiency and quality of care. Wider implementation is needed to validate these
findings, while cost-effectiveness analyses may further support their broad
adoption.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jay Simhan
- Einstein Healthcare Network, Philadelphia, PA, USA
| | - Arnold Bullock
- School of Medicine, Washington University, St Louis, MO, USA
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Sommer JL, Jacobsohn E, El-Gabalawy R. Impacts of elective surgical cancellations and postponements in Canada. Can J Anaesth 2020; 68:315-323. [PMID: 33085061 PMCID: PMC7575861 DOI: 10.1007/s12630-020-01824-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Worldwide, patients experience difficulties accessing elective surgical care. This study examined the perceived health, social, and functional impacts of elective surgical cancellations and postponements in Canada. Methods We analyzed a subset of aggregate data from the Canadian Community Health Survey (CCHS) annual components from 2005 to 2014. Multivariable logistic regressions examined associations between past-year non-emergency surgical cancellations/postponements and perceived impacts of waiting for surgery (e.g., worry/stress/anxiety, pain, loss of work, loss of income, deterioration of health, relationships suffered). Results Among those who experienced a cancellation or postponement of a past-year non-emergency surgery (weighted n = 256,836; 11.8%), 23.5% (weighted n = 60,345) indicated their life was affected by waiting for surgery. After adjusting for type of surgery, year, and sociodemographics, those who experienced a surgical cancellation or postponement had increased odds of reporting their life was affected by waiting for surgery (adjusted odds ratio [aOR], 2.67; 99% confidence interval [CI], 1.41 to 5.1); in particular, they reported greater deterioration of their health (aOR, 3.47; 99% CI, 1.05 to 11.4) and increased dependence on relatives/friends (aOR, 2.53; 99% CI, 1.01 to 6.3) than those who did not have a cancellation or postponement. Conclusion Results highlight the multifaceted perceived impacts of surgical cancellations/postponements. These findings suggest there is a need for improvements in reducing elective surgical cancellations and postponements. Results may also inform the development of targeted interventions to improve patients’ health and quality of life while waiting for surgery.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE211, Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, Canada
| | - Eric Jacobsohn
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE211, Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE211, Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada.
- Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, Canada.
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Okereke M, Ukor NA, Adebisi YA, Ogunkola IO, Favour Iyagbaye E, Adiela Owhor G, Lucero-Prisno DE. Impact of COVID-19 on access to healthcare in low- and middle-income countries: Current evidence and future recommendations. Int J Health Plann Manage 2020; 36:13-17. [PMID: 32857892 DOI: 10.1002/hpm.3067] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic continues to be a major public health threat globally and low- and middle-income countries (LMICs) are not an exception. The impact of the COVID-19 pandemic is far-reaching on many areas including but not limited to global health security, economic and healthcare delivery with a potential impact on access to healthcare in LMICs. We evaluate the impact of the COVID-19 pandemic on access to healthcare in LMICs, as well as plausible strategies that can be put in place to ensure that the delivery of healthcare is not halted. In order to mitigate the devastating effect of the COVID-19 pandemic on the already weak health systems in LMICs, it is much necessary to reinforce and scale up interventions and proactive measures that will ensure that access to healthcare is not disrupted even in course of the pandemic.
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Affiliation(s)
- Melody Okereke
- Faculty of Pharmaceutical Sciences, University of Ilorin, Ilorin, Nigeria
| | | | | | | | | | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Yu D, McClelland IS, Flahive S, Dia A, Mor-Avi V, Lang RM, Ward RP. Same-Day Cancellations of Transesophageal Echocardiography: Targeted Remediation to Improve Operational Efficiency. J Am Soc Echocardiogr 2020; 33:1409-1410. [PMID: 32792319 DOI: 10.1016/j.echo.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Dongbo Yu
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Isla S McClelland
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Sarah Flahive
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Abdulrahman Dia
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Victor Mor-Avi
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Roberto M Lang
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - R Parker Ward
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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Giedelman C, Covas Moschovas M, Bhat S, Brunelle L, Ogaya-Pinies G, Roof S, Corder C, Patel V, Palmer KJ. Establishing a successful robotic surgery program and improving operating room efficiency: literature review and our experience report. J Robot Surg 2020; 15:435-442. [PMID: 32691350 DOI: 10.1007/s11701-020-01121-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
The benefits and outcomes of robotic surgery are well established in the literature across multiple specialties. The increasing need for and dissemination of this technology associated with high costs, demand adequate planning during its implementation. Therefore, after years of training several robotic surgeons and establishing multiple robotic programs worldwide, the purpose of this article is to focus on the necessary elements in the initial phase of establishing a robotics program. We summarized in our article crucial factors when implementing a robotic program. Therefore, we explained in detail the critical aspects of the program design, implementation, marketing, research and outcomes, and ultimately improving efficiency. The creation of a robotics planning committee composed of several hospital individuals contributes in different lines of work such as cost evaluation, staff training, and OR modifications. A multidisciplinary approach and a robotic lead surgeon are also recommended to guarantee surgical volume and satisfactory outcomes. Furthermore, market analysis should evaluate the competition with other centres and potential surgical candidates in that area. Data collection should also be considered a vital element of the program organization, which assures quality control and helps to diagnose any program deficiency. We believe that the robotic program should be individualized according to the economy and reality of each centre. The success and duration of a robotic surgery program depend on long-term results. Therefore, careful planning with a robotic committee defining the types of procedures to be performed and appropriate multidisciplinary training to avoid surgery cancelations are crucial factors in establishing a successful program.
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Affiliation(s)
| | | | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, USA
| | | | | | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, USA
| | - Cathy Corder
- AdventHealth Global Robotics Institute, Celebration, USA
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, USA
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Colucci N, Gregoris A, Meyer J, Naiken SP, Staszewicz W, Gialamas E, Toso C, Abbassi Z. Introduction of a specialized consultation prior to insertion of totally implantable access venous devices: Impact on cancellation rate and patient satisfaction. Vascular 2020; 28:816-820. [PMID: 32508290 DOI: 10.1177/1708538120930470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Preoperative consultation is usually not performed before insertion of a totally implantable venous access device (TIVAD). In our experience, an incomplete preoperative assessment, a predictable medical condition contraindicating surgery, or no-show patients the day of surgery led to several surgery cancellations. Therefore, we introduced a specific preoperative surgical consultation for TIVAD that took place shortly before surgery. The aim of the present study is to evaluate the patients' satisfaction and to establish the rate of cancellation after the adoption of this strategy. METHODS Two-hundred and four patients who benefited from the preoperative consultation before TIVAD insertion from August 2014 to August 2016 were included. Satisfaction of patients and cancellation rate were documented. RESULTS With that strategy, no TIVAD insertion was either delayed or cancelled. The overall level of satisfaction was high (91.8%); 184 patients (90.2%) judged the consultation useful in preparation for the surgery. The surgical procedure met their expectations in 92.2% of cases. Patients known for a psychiatric comorbidity were more likely to express dissatisfaction. CONCLUSIONS The introduction of a specific preoperative surgical consultation for TIVAD insertion led to a high level of patients' satisfaction. After the preoperative consultation, no cancellation was recorded. Special approaches have to be considered for patients with a psychiatric comorbidity.
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Affiliation(s)
- Nicola Colucci
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy
| | - Adrien Gregoris
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Jeremy Meyer
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Surennaidoo Perumal Naiken
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Wojciech Staszewicz
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Christian Toso
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS, Otero J, Callegaro D, Warner SG, Baxter NN, Teh CSC, Ng-Kamstra J, Meara JG, Hagander L, Lorenzon L. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 107:1250-1261. [PMID: 32350857 PMCID: PMC7267363 DOI: 10.1002/bjs.11670] [Citation(s) in RCA: 482] [Impact Index Per Article: 120.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Background The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J Hallet
- Department of Surgery, Sunnybrook and University of Toronto, Toronto, Ontario, Canada
| | - J B Matthews
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A A Schnitzbauer
- Department for General, Visceral and Transplant Surgery, Frankfurt University Hospital, Goethe University, Frankfurt/Main, Germany
| | - P D Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P B S Lai
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - J Otero
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | - D Callegaro
- Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milan, Spain
| | - S G Warner
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - N N Baxter
- Melbourne School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - C S C Teh
- Institute of Surgery, St Luke's Medical Centre, Metro Manila, Philippines.,Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney and Transplant Institute, Quezon City, Philippines
| | - J Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - L Hagander
- Lund University WHO Collaborating Centre for Surgery and Public Health, Paediatric Surgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - L Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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Miri Bonjar M, Khammarnia M, Bakhshi M, Ansari-Moghaddam A, Okati-Aliabad H, Mohammadi M. Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019846385. [PMID: 31587603 PMCID: PMC6778997 DOI: 10.1177/0046958019846385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients’ basic treatment needs and reduction of patients’ out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types (P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.
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Matzek LJ, Smith BB, Mauermann WJ, Bower TC, Smith MM. Same-Day Cancellation in Vascular Surgery: 10-Year Review at a Large Tertiary Care Center. Ann Vasc Surg 2020; 62:349-355. [DOI: 10.1016/j.avsg.2019.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
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Rajaguru PP, Jusabani MA, Massawe H, Temu R, Sheth NP. Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania. Glob Health Res Policy 2019; 4:30. [PMID: 31673630 PMCID: PMC6816166 DOI: 10.1186/s41256-019-0122-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa. Methods The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed. Results In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients). Conclusion While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.
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Affiliation(s)
- Praveen Paul Rajaguru
- 1Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA USA
| | | | - Honest Massawe
- Department of Orthopaedic Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Rogers Temu
- Department of Orthopaedic Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Neil Perry Sheth
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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Felbaum DR, Stewart JJ, Anaizi AN, Sandhu FA, Nair MN, Voyadzis JM. Implementation and Evaluation of a Smartphone Application for the Perioperative Care of Neurosurgery Patients at an Academic Medical Center: Implications for Patient Satisfaction, Surgery Cancelations, and Readmissions. Oper Neurosurg (Hagerstown) 2019; 14:303-311. [PMID: 28541569 DOI: 10.1093/ons/opx112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 04/11/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smartphone applications (apps) in the health care arena are being increasingly developed with the aim of benefiting both patients and their physicians. The delivery of adequate instructions both before and after a procedure or surgery is of paramount importance in ensuring the best possible outcome for patients. OBJECTIVE To demonstrate that app-based instructions with built-in reminders may improve patient understanding and compliance and contribute to reducing the number of surgery cancellations and postoperative complications and readmissions. METHODS We prospectively accrued 56 patients undergoing routine neurosurgery procedures who subsequently downloaded the app. The median age was 54 (range 27-79). Patients were followed for successful registration and use of the app, compliance with reading instructions before and after surgery, and sending pain scores and/or wound images. The number of surgeries cancelled, postoperative complications, 30-d readmissions, and phone calls for surgery-related questions were examined. RESULTS Fifty-four of the 56 patients successfully registered, downloaded, and used the app and read and complied with instructions both before and after surgery. There were no cancelled surgeries. There was 1 postoperative complication. There were no readmissions. Eight of the 54 patients (14.8%) called the office on a single occasion for a surgery related question. CONCLUSION We demonstrate the utility of a smartphone application in the perioperative neurosurgical care setting with regard to patient compliance and satisfaction as well as surgery cancellations and readmissions. Further study of a larger number of patients with a control group is warranted.
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Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | | | - Amjad N Anaizi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Mani N Nair
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
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Liu L, Ni Y, Zhang N, Nick Pratap J. Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children's surgery. Int J Med Inform 2019; 129:234-241. [PMID: 31445261 DOI: 10.1016/j.ijmedinf.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/13/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Last-minute surgery cancellation represents a major wastage of resources and can cause significant inconvenience to patients. Our objectives in this study were: 1) To develop predictive models of last-minute surgery cancellation, utilizing machine learning technologies, from patient-specific and contextual data from two distinct pediatric surgical sites of a single institution; and 2) to identify specific key predictors that impact children's risk of day-of-surgery cancellation. METHODS AND FINDINGS We extracted five-year datasets (2012-2017) from the Electronic Health Record at Cincinnati Children's Hospital Medical Center. By leveraging patient-specific information and contextual data, machine learning classifiers were developed to predict all patient-related cancellations and the most frequent four cancellation causes individually (patient illness, "no show," NPO violation and refusal to undergo surgery by either patient or family). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) using ten-fold cross-validation. The best performance for predicting all-cause surgery cancellation was generated by gradient-boosted logistic regression models, with AUC 0.781 (95% CI: [0.764,0.797]) and 0.740 (95% CI: [0.726,0.771]) for the two campuses. Of the four most frequent individual causes of cancellation, "no show" and NPO violation were predicted better than patient illness or patient/family refusal. Models showed good cross-campus generalizability (AUC: 0.725/0.735, when training on one site and testing on the other). To synthesize a human-oriented conceptualization of pediatric surgery cancellation, an iterative step-forward approach was applied to identify key predictors which may inform the design of future preventive interventions. CONCLUSIONS Our study demonstrated the capacity of machine learning models for predicting pediatric patients at risk of last-minute surgery cancellation and providing useful insight into root causes of cancellation. The approach offers the promise of targeted interventions to significantly decrease both healthcare costs and also families' negative experiences.
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Affiliation(s)
- Lei Liu
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Yizhao Ni
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nanhua Zhang
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Nick Pratap
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Same-Day Cancellation in Ambulatory Surgery: A Retrospective Review at a Large Academic Tertiary Referral Center. J Ambul Care Manage 2019; 41:118-127. [PMID: 29474251 DOI: 10.1097/jac.0000000000000226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although ambulatory surgery offers patients convenience and reduced costs, same-day cancellation of ambulatory surgery negatively affects patient experiences and operational efficiency. We conducted a retrospective analysis to determine the frequency and reasons for same-day cancellations in an outpatient surgery center at a large academic tertiary referral center. Of 41 389 ambulatory surgical procedures performed, same-day cancellations occurred at a rate of 0.5% and were usually unforeseeable in nature. Focusing on foreseeable cancellations offers opportunities for enhanced patient satisfaction, improved quality of care, and systems-based practice improvements to mitigate cancellations related to areas such as scheduling or patient noncompliance.
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Tan AL, Chiew CJ, Wang S, Abdullah HR, Lam SS, Ong ME, Tan HK, Wong TH. Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study. Int J Surg 2019; 66:72-78. [PMID: 31029875 DOI: 10.1016/j.ijsu.2019.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Operating Theatre (OT) is the largest cost centre as well as the main revenue generator in most hospitals. One of the common problems affecting optimal OT utilization is the cancellation of scheduled surgeries. The goal of this study was to identify factors associated with cancellation within 24 h of scheduled surgeries in a tertiary hospital. METHODS All elective surgeries performed on adults 18 years and above between June 2015 and December 2016 were included. Cancellations ≤24 h from the scheduled start time of the surgery were recorded, with their reasons for cancellation. Data relating to the patient, surgeon and planned surgery were obtained from the hospital operational database. Univariate analysis and multivariable analysis were conducted using logistic regression. RESULTS A total of 4060 scheduled surgeries were included, of which 398 (9.8%) were cancelled within 24 h of surgery. On multivariate analysis, cancellation within 24 h of surgery was associated with history of heart failure (Adjusted odds ratio, AOR1.65; 95%CI 1.08-2.50), advanced chronic kidney disease (AOR2.33; 95%CI 1.58-3.39), or a history of hip fracture (AOR2.29; 95%CI 1.33-3.80), low socio-economic status (on Medifund financing, AOR3.16; 95%CI 1.37-6.72), history of ≥4 cancelled surgeries in the past 3 years (AOR2.38; 95%CI 1.30-4.19), and scheduled time in the afternoon (AOR1.83; 95%CI 1.44-2.32) and evening (AOR2.09; 95%CI0.73-5.13), compared to the morning. Attendance at preoperative anaesthesia assessment clinic was associated with reduced likelihood of cancellation (AOR0.55; 95%CI0.43-0.72). CONCLUSIONS Several patient and system factors can be used to identify scheduled surgeries that are at high likelihood of cancellation within 24 h of surgery, which may inform strategies to improve the efficiency of OT utilization, including having a dedicated preoperative anaesthesia assessment clinic.
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Affiliation(s)
- Aidan L Tan
- Preventive Medicine, National University Hospital, Singapore, 1E Kent Ridge Road, 119 228, Singapore; Health Services Research Unit, Singapore General Hospital, Singapore, 226 Outram Rd, 169039, Singapore
| | - Calvin J Chiew
- Preventive Medicine, National University Hospital, Singapore, 1E Kent Ridge Road, 119 228, Singapore; Health Services Research Unit, Singapore General Hospital, Singapore, 226 Outram Rd, 169039, Singapore
| | - Sijia Wang
- Integrated Health Information Systems, Singapore, 6 Serangoon North Avenue 5, #01-01/02, 554910, Singapore
| | - Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore, Outram Road, 169608, Singapore; Duke-NUS Medical School, Singapore, 8 College Rd, 169857, Singapore
| | - Sean Sw Lam
- Health Services Research Centre, Singapore Health Services, Singapore, 20 College Road, The Academia, Discovery Tower, Level 6, 169856, Singapore
| | - Marcus Eh Ong
- Duke-NUS Medical School, Singapore, 8 College Rd, 169857, Singapore; Health Services Research Centre, Singapore Health Services, Singapore, 20 College Road, The Academia, Discovery Tower, Level 6, 169856, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Outram Road, 169608, Singapore
| | - Hiang Khoon Tan
- Duke-NUS Medical School, Singapore, 8 College Rd, 169857, Singapore; Singhealth Duke-NUS Head and Neck Centre, Singapore, Outram Road, 169608, Singapore
| | - Ting Hway Wong
- Duke-NUS Medical School, Singapore, 8 College Rd, 169857, Singapore; Department of General and Trauma Surgery, Singapore General Hospital, Singapore, Outram Road, 169608, Singapore.
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Salehnejad R, Ali M, Proudlove N. Combining regression trees and panel regression for exploring and testing the impact of complementary management practices on short-notice elective operation cancellation rates. Health Syst (Basingstoke) 2019; 9:326-344. [PMID: 33354324 PMCID: PMC7738292 DOI: 10.1080/20476965.2019.1596338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/20/2018] [Accepted: 03/11/2019] [Indexed: 10/27/2022] Open
Abstract
Variation in the performance of providers across healthcare systems is pervasive. It is recognised as both a major concern and an opportunity for learning and improvement. Variation between providers is broadly considered to be due to management practices and contextual factors such as catchment-area demographics. However, there is little understanding of the ways in which these impact on performance and how they can be measured. We use recent developments in both regression trees and panel regression techniques to explore and then statistically test complementary alignments of management practices whilst taking into account contextual factors. We apply this to 5 years of NHS hospital trust data, examining performance on short-notice cancellation rates. We find that different alignments of management practices give rise to quite different short-notice cancellation rates between trusts, with some being substantially lower. Our research offers a data-driven approach for identifying optimal clusters of management practices.
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Affiliation(s)
- Reza Salehnejad
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Manhal Ali
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW Operating rooms are critical financial centers for hospital systems, with surgical care representing about a third of all health care spending. However, not all of the costs are appropriate or necessary, as there are sometimes significant inefficiencies in how operating rooms are utilized. RECENT FINDINGS Recent innovations utilizing patient-centered data, systems principles from manufacturing industries, and enhanced communication processes have made significant improvements in improving operating room efficiency. By focusing on improving communication, standardizing processes, and embracing a learning health system with innovations, significant improvements in operating room efficiency can be seen to improve outcomes and costs for the health system and patient.
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Affiliation(s)
- Daniel J Lee
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, West Pavilion 3rd Floor, Philadelphia, PA, 19104, USA.
| | - James Ding
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Guzzo
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Reducing Preventable Surgical Cancellations: Improving the Preoperative Anesthesia Interview Process. J Perianesth Nurs 2019; 34:929-937. [PMID: 30894294 DOI: 10.1016/j.jopan.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Thorough and accurate preoperative anesthesia interviews may help improve perioperative efficiency by reducing unnecessary preoperative testing and preventable surgical cancellations, both of which create financial burdens. Standardized anesthesia preoperative interview guidelines and online educational modules for registered nurses (RNs) conducting preoperative interviews may improve this process. DESIGN Predesign and postdesign, retrospective chart review. METHODS Online educational modules and standardized preoperative anesthesia interview guidelines were developed for RNs conducting preoperative interviews. A retrospective chart review compared preoperative anesthesia interview record completion rates, compliance with laboratory testing, and the total number of preventable surgical cancellations. FINDINGS Documentation of preoperative anesthesia interview records increased, whereas unnecessary preoperative testing decreased, neither with statistical significance. Preventable cancellation rates decreased significantly from 34.3% to 20% (P < .5) contributing to a 3-month postimplementation cost savings of approximately $30,000. CONCLUSIONS A standardized preoperative anesthesia interview guideline and online anesthesia educational modules for RNs conducting preoperative anesthesia interviews improved preoperative record completion rates, reduced unnecessary laboratory testing, and averted surgical cancellations.
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Stewart JJ, Fayed I, Henault S, Kalantar B, Voyadzis JM. Use of a Smartphone Application for Spine Surgery Improves Patient Adherence with Preoperative Instructions and Decreases Last-minute Surgery Cancellations. Cureus 2019; 11:e4192. [PMID: 31106092 PMCID: PMC6504025 DOI: 10.7759/cureus.4192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Smartphone applications (apps) are being increasingly utilized in the health care arena to improve patient care and outcomes. Objective: To further demonstrate the ability of a smartphone app to improve patient compliance with preoperative instructions and to decrease the number of last-minute surgery cancellations. Methods: Patients undergoing spine surgery were prospectively accrued. Smartphone app users were compared to non-app users. Patient adherence with preoperative instructions as well as last-minute surgery cancellations were analyzed. Results: All 85 app users adhered to preoperative instructions according to the acknowledgements sent to the web portal, and there were no cancelled surgeries. Among the 89 non-app users, there were five cancelled surgeries (5.6%). Conclusions: We demonstrate the ability of a smartphone application to improve patient adherence with preoperative instructions and decrease last-minute surgery cancellations.
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Affiliation(s)
- Jeffrey J Stewart
- Miscellaneous, Georgetown University School of Medicine, Washington DC, USA
| | - Islam Fayed
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Shawnda Henault
- Miscellaneous, Georgetown University School of Medicine, Washington DC, USA
| | - Babak Kalantar
- Orthopaedics, Medstar Georgetown University Hospital, Washington DC, USA
| | - Jean-Marc Voyadzis
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
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