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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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2
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Vergouwen M, Tarcea A, Van Essen D, Sayre EC, White NJ. FROST 2.0: Factors Predicting Orthopaedic Trauma Volumes - A Validation Study. Injury 2023; 54:111111. [PMID: 37839917 DOI: 10.1016/j.injury.2023.111111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The anecdotal relationship between weather, season, and orthopaedic trauma volumes is understood by patients and healthcare providers: when the winter ground is icy, people fall. Previous research established that winter and summer months as well as ice and snow were significant predictors of orthopaedic trauma and surges in volumes. The current study validates the previously established predictive model in one Canadian city; the original methods were repeated using a new, yet geographically similar dataset. The effect of month and ice were consistent, which suggests the proposed model has sufficient external validity to guide resource allocation and primary prevention strategies.
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Affiliation(s)
- Martina Vergouwen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada.
| | - Adina Tarcea
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Darren Van Essen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 Number 3 Rd, V6X 2C7 Richmond, BC Canada
| | - Neil J White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
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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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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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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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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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Koren SF, Engel LE, Møller MP. Preoperative psychogenic fever: to operate or not to operate. J Surg Case Rep 2021; 2021:rjab114. [PMID: 33815760 PMCID: PMC8007217 DOI: 10.1093/jscr/rjab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Postponing elective surgery because of fever on the morning of the operation is frustrating for patients as well as doctors. It is also not cost effective and the unused operation capacity could have been used on other patients. On the other hand, surgery and general anaesthesia will put unwanted physiological strain on a patient fighting an on-going infection. Preoperative fever therefore poses a dilemma; to proceed with-, or to postpone the scheduled operation. We report a case where a 58-year-old woman, scheduled for prophylactic bilateral mastectomy and primary implant-based reconstruction, was postponed because of a temperature of 37.9°C. The morning of her new operation date, she developed a fever of 39.2°C which fell to 38.2°C shortly after administration of 0.25 mg triazolam. She was diagnosed with psychogenic fever, and we went through with the operation, even though the patient was febrile. The operation was successful, and she had no post-operative complications.
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Affiliation(s)
- Sondre F Koren
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Lilan E Engel
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Michael P Møller
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
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Blas-Benites KG, Matzumura-Kasano JP, Hugo GC. Frequency and causes of suspension of gynecological surgeries and patient satisfaction: Hospital III EsSalud, Lima-Perú. ACTA ACUST UNITED AC 2020; 71:356-364. [PMID: 33515442 DOI: 10.18597/rcog.3594] [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: 09/08/2020] [Accepted: 11/20/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the frequency of gynecological surgery cancellation as well as the factors leading up to cancellation, and to examine how patients perceive this situation. METHODS Case series including patients over 18 years of age scheduled for gynecological surgery due to benign conditions whose surgery was cancelled in a general referral hospital in Lima, Peru, between June 2019 and March 2020. Baseline characteristics of the patients and the reasons for cancellation were assessed, and the Patient Satisfaction Questionnaire Short Form (PSQ-18) tool was administered. Descriptive analysis. RESULTS The study included 84 patients. During the study period, the frequency of surgery cancellations was 11 %. Medical reasons were the main factor for surgery suspension, at 46.5 %; administrative causes accounted for 36.6 % of the cancellations, due mainly to lack of operation time in 25.4 %. In terms of satisfaction, 21,4 % of the patients were satisfied with the cancellation. CONCLUSIONS Good communication with patients whose surgery needs to be cancelled is essential. Further studies that look into this problem in our region are required.
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Affiliation(s)
| | - Juan Pedro Matzumura-Kasano
- Médico ginecoobstetra. Presidente de la Sociedad Peruana de Obstetricia y Ginecología; vicedecano de Investigación y Posgrado, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima (Perú)
| | - Gutiérrez-Crespo Hugo
- Profesor auxiliar, Facultad de Medicina de la Universidad Nacional Mayor de San Marcos; magíster en Docencia e Investigación en Salud, Lima (Perú)
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Viftrup A, Dreyer P, Nikolajsen L, Holm A. Surgery cancellation: A scoping review of patients' experiences. J Clin Nurs 2020; 30:357-371. [PMID: 33258277 DOI: 10.1111/jocn.15582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To review the literature on patients' experiences of surgery cancellation to gain knowledge of nursing care needs and identify gaps in evidence. BACKGROUND Surgery cancellations are an ongoing challenge in healthcare systems with negative impacts on healthcare costs, hospital staff and patients. Most research addresses the reasons for cancellation and implementation of preventive interventions, but limited knowledge exists about patients' experiences of cancellation. DESIGN The scoping review was undertaken using the methodology recommended by the Joanna Briggs Institute for Scoping Reviews and the Reporting Cheklist for Scoping Reviews (PRISMA-ScR). METHODS A systematic search was conducted by two independent researchers in Cochrane Library, CINAHL, PubMed and PsycINFO. A forward and backward citation search was performed in Scopus, and references in relevant studies were explored. The tool Covidence was applied to select, compare and discuss relevant articles. The Mixed Methods Appraisal Tool was used for critical appraisal. RESULTS Surgery cancellation is emotionally harmful with negative effects on patients. Four themes were identified: 'Initial reactions to cancellation', 'Reactions during a new waiting period at home and during readmission to hospital', 'Information about cancellation' and 'The experience of new practical arrangements'. Patients whose surgery was cancelled experienced initial feelings such as anger, rejection and anxiety and physical/psychosomatic symptoms in the extended waiting period. Patients prefered early sufficient information about cancellation from the surgeon. The practical arrangements were stressfull for the patients. CONCLUSION Nursing care and identification of vulnerable patients are essential to prevent negative effects in the extended waiting period. Provision of timely, sufficient and professional information about cancellation from the surgeon is important. Further research assessing consequences of cancellation is needed. RELEVANCE TO CLINICAL PRACTICE Patients would benefit if hospitals find systems to minimise cancellation, and healthcare professionals could systematically develop professional supportive interventions tailored to patients' individual needs.
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Affiliation(s)
- Anette Viftrup
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Bergen University, Bergen, Norway
| | - Lone Nikolajsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Holm
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Charlesworth M, Pandit JJ. Rational performance metrics for operating theatres, principles of efficiency, and how to achieve it. Br J Surg 2020; 107:e63-e69. [PMID: 31903597 DOI: 10.1002/bjs.11396] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several performance metrics are commonly used by National Health Service (NHS) organizations to measure the efficiency and productivity of operating lists. These include: start time, utilization, cancellations, number of operations and gap time between operations. The authors describe reasons why these metrics are flawed, and use clinical evidence and mathematics to define a rational, balanced efficiency metric. METHODS A narrative review of literature on the efficiency and productivity of elective NHS operating lists was undertaken. The aim was to rationalize how best to define and measure the efficiency of an operating list, and describe strategies to achieve it. RESULTS There is now a wealth of literature on how optimally to measure the performance of elective surgical lists. Efficiency may be defined as the completion of all scheduled operations within the allocated time with no over- or under-runs. CONCLUSION Achieving efficiency requires appropriate scheduling using specific procedure mean (or median) times and their associated variance (standard deviation or interquartile range) to calculate the probability they can be completed on time. The case mix may be adjusted to yield better time management. This review outlines common misconceptions applied to managing scheduled operating theatre lists and the challenges of measuring unscheduled operations in emergency settings.
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Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Ding BTK, Soh T, Tan BY, Oh JYL, Mohd Fadhil MFB, Rasappan K, Lee KT. Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore. J Bone Joint Surg Am 2020; 102:e67. [PMID: 32618915 PMCID: PMC7396219 DOI: 10.2106/jbjs.20.00568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤With severe limitations in manpower, facilities, and equipment, and the concern for nosocomial transmission, operating in a pandemic is fraught with danger from multiple fronts. ➤Strategies to mitigate nosocomial spread include prioritization of existing patients, triaging and treatment of new patient encounters, infection control protocols, perioperative considerations, manpower management, and novel strategies for interdisciplinary interaction and education. ➤The decision to proceed with or postpone surgery should be based on the urgency of the surgical procedure and the physiological health of the patient. ➤When performing an operation on a patient who has suspected or confirmed infection with novel coronavirus disease 2019 (COVID-19), personal protection equipment should include hair covers, face shields or goggles, N95 respirator masks, a blood-borne pathogen-resistant surgical gown, shoe covers, and double-gloving with single-use gloves. ➤Loose-fitting, powered air-purifying respirators should be considered for prolonged surgeries. ➤An astutely formulated and comprehensive business continuity plan is an orthopaedic unit’s best strategy for maintaining critical standards, discipline, and morale in severe and prolonged outbreaks.
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Affiliation(s)
| | - Tamara Soh
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | - Kumaran Rasappan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda: A Cross-Sectional Study. Surg Res Pract 2020; 2020:1464098. [PMID: 32258365 PMCID: PMC7115171 DOI: 10.1155/2020/1464098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/26/2019] [Accepted: 02/19/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction. The cancellation of elective procedures has been shown to waste resources and to have the potential to increase morbidity and mortality among patients. This study aimed to determine the prevalence of the cancellation of elective surgical procedures and to identify the factors associated with these cancellations at Mulago Hospital, a large public hospital in Kampala, Uganda.
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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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14
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Doubova SV, Infante-Castañeda C, Roder-DeWan S, Pérez-Cuevas R. User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico. BMC Health Serv Res 2019; 19:872. [PMID: 31752851 PMCID: PMC6873740 DOI: 10.1186/s12913-019-4706-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals. METHODS We conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study's independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals. RESULTS The study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction. CONCLUSION Patient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Zip Code: 06720, Mexico City, Mexico.
| | | | - Sanam Roder-DeWan
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Ricardo Pérez-Cuevas
- Center for Health Systems Research, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Zip Code: 62100, CuernavacaCity, Mexico.,Division of Social Protection and Health, Jamaica Country Office, InterAmerican Development Bank, 6 Montrose road, Kingston, Jamaica
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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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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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Al Talalwah N, McIltrot KH. Cancellation of Surgeries: Integrative Review. J Perianesth Nurs 2018; 34:86-96. [PMID: 29678319 DOI: 10.1016/j.jopan.2017.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/19/2017] [Accepted: 09/22/2017] [Indexed: 10/17/2022]
Abstract
PURPOSE To analyze cancellations of surgeries and identify evidence-based interventions to address this issue. DESIGN Integrative literature review. METHODS An integrative literature search was conducted in four databases: CINAHL, PubMed, Embase, and Cochrane and included literature sources dated January 2011 to January 2016. The complete list of search terms consisted of the following: ambulatory surgery, day surgery center, elective surgical procedure, elective operation, elective surgery, schedule, access to care, surgery cancellation, operation cancellation, and surgery delay. FINDINGS Twenty-three literature sources were identified. Evidence included one randomized controlled trial and multiple studies. Causes of cancellations were classified into three categories: hospital-related reasons, patient-related reasons, and surgeon-related reasons. Evidence confirmed most cancellations were avoidable. CONCLUSIONS Cancellation of scheduled surgeries has a significant impact on patients' health, resources, cost, and quality of care. It is difficult to devise a solution without understanding the cause of cancellations.
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18
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Caesar U, Karlsson J, Hansson E. Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years. Patient Saf Surg 2018; 12:2. [PMID: 29344088 PMCID: PMC5763611 DOI: 10.1186/s13037-018-0149-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/04/2018] [Indexed: 01/24/2023] Open
Abstract
Background Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit and/or the patients’ health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. Method The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. Result We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. Conclusion A large number of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.
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Affiliation(s)
- Ulla Caesar
- 1Sahlgrenska Academy, Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg Sweden, Gothenburg, Sweden.,3Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jon Karlsson
- 1Sahlgrenska Academy, Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg Sweden, Gothenburg, Sweden.,3Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Hansson
- 2Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg Sweden, Gothenburg, Sweden.,3Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Proudlove NC, Samarasinghe BS, Walshe K. Investigating consistent patterns of variation in short-notice cancellations of elective operations: The potential for learning and improvement through multi-site evaluations. Health Serv Manage Res 2017; 31:111-119. [PMID: 29256264 DOI: 10.1177/0951484817745064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As part of efforts to increase productivity in healthcare, there is considerable interest in the extent and causes of variation in the performance of provider organisations. In this study, we use publically available data from the English NHS to examine the characteristics of variation in the rates of short-notice cancellations of elective operations due to hospital reasons (e.g. lack of the required resources such as operating theatres and beds). We find that the variation between hospital trusts is very non-random. There is a fourfold difference in the cancellation rates between the top and bottom deciles of performance. Little is known about the causes of this. There is a large and striking consistency in the relative performance of hospital trusts on cancellation rates over the last five years. Thus, the best and worst performers are consistently relatively very good or very poor, so a multi-site comparison of practices, and accounting for confounds like patient demographics, could be very valuable to inform both this knowledge gap and practice in healthcare. Of particular interest is that the cancellation rates could be a symptom of deeper issues with the efficiency of patient flows within hospitals.
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Affiliation(s)
- Nathan C Proudlove
- 1 Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Kieran Walshe
- 1 Alliance Manchester Business School, University of Manchester, Manchester, UK
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20
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A Literature Review on Validated Simulations of the Surgical Services. J Med Syst 2017; 41:61. [PMID: 28271463 DOI: 10.1007/s10916-017-0711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
The surgical department is a critical unit that oversees multiple surgical-based clinical pathways and works with various other units in a hospital. This department faces numerous challenges relating to variability in demand and management of resources. The aim of this article is to review the application of validated simulation models on hospital-wide surgical services. Each of these models is broadly classified by (i) simulation method and (ii) level of detail given to the management of "patient pathways" and "staff workflows". We remark that very few studies have given attention to the management of staff workflows in their validated simulation models.
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21
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Ivarsson B, Larsson S, Sjöberg T. Patients' Experiences of Support while Waiting for Cardiac Surgery. A Critical Incident Technique Analysis. Eur J Cardiovasc Nurs 2016; 3:183-91. [PMID: 15234322 DOI: 10.1016/j.ejcnurse.2004.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Revised: 12/29/2003] [Accepted: 03/15/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients waiting for cardiac surgery experience the period from decision about surgery to the operation as long, heavy and dreary. AIMS The aim was to describe patients' experiences of support in the form of important events during the waiting period. METHODS The design was qualitative and the 'critical incident' technique was used. Incidents were collected via interviews with 26 patients waiting for heart surgery. The selection of patients was strategic. RESULTS In all, 223 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Internal factors describe how an experience of support was influenced by changes in life style and by finding strength from within. External factors describe how experiences of support was influenced by being allowed to participate in care management, by receiving attention, as well as by the health care organisation and the social network. CONCLUSION By identifying factors that influence patients' experiences of support while they wait for heart surgery, institutional and non-institutional health-care services can improve the organisation of the entire health care process, and develop patient-focused support programmes.
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Affiliation(s)
- Bodil Ivarsson
- Department of Cardiothoracic Surgery, University Hospital of Lund, Barngatan 2, SE-221 85 Lund, Sweden.
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22
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Fitzsimons MG, Dilley JD, Moser C, Walker JD. Analysis of 43 Intraoperative Cardiac Surgery Case Cancellations. J Cardiothorac Vasc Anesth 2015; 30:19-22. [PMID: 26597766 DOI: 10.1053/j.jvca.2015.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Late cancellation of surgery cases imposes significant emotional distress on the patient and their family and results in wasted resources, including loss of operating room and personnel time. This study was designed to determine the causes of cancellation, preventability, total operating room time, and postoperative destination. DESIGN This study was a retrospective review of the 43 cardiac surgical cases that were cancelled while the patient was in the operating room (OR) but prior to surgical incision. SETTING The cases were performed at the Massachusetts General Hospital, a teaching hospital of Harvard Medical School. PARTICIPANTS Forty-three out of 5,110 scheduled cardiac cases were identified that were cancelled after the patient had entered the operating room between January 1, 2010 and December 31, 2013. INTERVENTIONS No interventions were made. This was a retrospective study. MEASUREMENTS AND MAIN RESULTS The most common causes of cancellation included a change in the patient's health status (44%), problems associated with central catheter placement (18.6%), and unsatisfactory donor organs for planned transplantation (12%). The majority were inpatients (65%) prior to the procedure. The cumulative OR time for all cancelled cases was 5,374 minutes (89 hours and 34 minutes). CONCLUSIONS The reason for cancellation, preventability, total operating room time, and postoperative destination were determined. The information can be utilized to decrease the number of future cancellations.
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Affiliation(s)
- Michael G Fitzsimons
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA
| | - Joshua D Dilley
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
| | - Chris Moser
- Lahey Hospital and Medical Center, Department of Anesthesiology, Burlington, MA
| | - Jennifer D Walker
- UMass Memorial Medical Center-University Campus, Department of Cardiac Surgery, Worcester, MA
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23
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Johnson EC, Horwood J, Gooberman-Hill R. Conceptualising time before surgery: the experience of patients waiting for hip replacement. Soc Sci Med 2014; 116:126-33. [PMID: 24997442 PMCID: PMC4124516 DOI: 10.1016/j.socscimed.2014.06.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/22/2022]
Abstract
Interpretations of time underlie patients' experiences of illness and the way in which the National Health Service (NHS) is organised. In the NHS, achieving short waiting times for treatment is seen as important, and this is particularly evident in relation to chronic conditions where the time waiting in care from onset of symptoms to successful management can last months and years. One example of a chronic condition with high prevalence is osteoarthritis, estimated to affect 10% of people aged over 55 years in the UK. Osteoarthritis of the hip is particularly common, and treatments include exercise and medication. If these options do not provide enough relief from pain and functional difficulties, then joint replacement may be considered. With over 70,000 such operations conducted every year in England and Wales, processes relating to waiting times impact on many patients. This article explores how 24 patients with osteoarthritis experience time during the lead up to hip replacement surgery. We draw on data collected during longitudinal in-depth interviews with patients a median of 9.5 days before surgery and at two to four weeks post-operatively. Transcripts of audio-recorded interviews were imported into Atlas.ti® and inductive thematic analysis undertaken. Increasing pain and deterioration in function altered the experience of time during the journey towards hip replacement. Patients made essential changes to how they filled their days. They experienced lost and wasted time and faced disruption to the temporal order of their lives. A surgical date marked in the calendar became their focus. However, this date was not static, moving because of changing perceptions of duration and real-time alterations by the healthcare system. Findings highlight that patients' experience of time is complex and multi-dimensional and does not reflect the linear, monochronic conceptualisation of time embedded in the healthcare system. Waiting for hip replacement disrupts the temporal order of patients' lives. Patients' perceptions of time are multi-dimensional and complex. Experiences of time differ from health services' monochronic construction of time.
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Affiliation(s)
- Emma C Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
| | - Jeremy Horwood
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
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Caesar U, Karlsson J, Olsson LE, Samuelsson K, Hansson-Olofsson E. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases. Patient Saf Surg 2014; 8:24. [PMID: 24955115 PMCID: PMC4064269 DOI: 10.1186/1754-9493-8-24] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery. METHODS The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once. RESULTS Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations. CONCLUSIONS In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.
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Affiliation(s)
- Ulla Caesar
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden
| | - Lars-Eric Olsson
- Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden
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Smith MM, Mauermann WJ, Cook DJ, Hyder JA, Dearani JA, Barbara DW. Same-day cancellation of cardiac surgery: a retrospective review at a large academic tertiary referral center. J Thorac Cardiovasc Surg 2014; 148:721-5. [PMID: 24698559 DOI: 10.1016/j.jtcvs.2014.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/27/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Same-day cancellations of cardiac surgery are unfortunate and costly occurrences that potentially place patients at risk of adverse events. METHODS We retrospectively reviewed all same-day cancellations of cardiac operations requiring cardiopulmonary bypass from 2010 to 2012 at a large academic tertiary referral center. RESULTS Of 7081 cardiac operations, 134 patients experienced 142 same-day cancellations of cardiac surgery. The foreseeable cancellation causes comprised 17% of cancellations, nonforeseeable 59%, and indeterminate 24%. The reasons for cancellation were medical (51%), administrative or scheduling (17%), unknown (12%), procedure no longer required (11%), patient cancellation (6%), and preincisional complication (3%). The mean interval from the patient seeing a nonsurgeon provider to cancellation was 8.6 ± 16.2 days. No statistically significant differences existed between the foreseeable and nonforeseeable cancellations and the timing of the visit to a nonsurgeon provider (15, 30, 45, and 60 days) before cancellation. Seven patients (5%) had died within 30 days of cancellation. Of those subsequently operated on, the mean interval from cancellation to performance of the operation was 12.2 ± 22.7 days. Of the 142 cancelled surgical procedures, 28 (20%) were never subsequently performed. CONCLUSIONS Same-day cancellation of cardiac surgery occurred infrequently (2% of cardiac operations performed) at our institution. The cancellations were for foreseeable causes in a few cases. Seeing a nonsurgeon provider more recently before cancellation was not significantly associated with nonforeseeable versus foreseeable cancellations. Although uncommon at our institution, same-day cancellations should be viewed as an opportunity for practice improvement, given the foreseeable nature of some cancelations, associated 30-day mortality, and portion of patients not subsequently undergoing cardiac surgery.
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Affiliation(s)
- Mark M Smith
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn
| | - William J Mauermann
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn
| | - David J Cook
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Joseph A Hyder
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Department of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - David W Barbara
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Department of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
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26
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Hovlid E, von Plessen C, Haug K, Aslaksen AB, Bukve O. Patient experiences with interventions to reduce surgery cancellations: a qualitative study. BMC Surg 2013; 13:30. [PMID: 23924167 PMCID: PMC3750692 DOI: 10.1186/1471-2482-13-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied how patients experienced interventions to reduce cancellations. METHODS We conducted a comparative, qualitative case study by interviewing 8 patients who had experienced the redesigned pathway, and 8 patients who had experienced the original pathway. We performed a content analysis of the interviews using a theory-based coding scheme. Through a process of coding and condensing, we identified themes of patient experience. RESULTS We identified three common themes summarizing patients' positive experiences with the effects of the interventions: the importance of being involved in scheduling time for surgery, individualized preparation before the hospital admission, and relationships with few clinicians during their hospital stay. CONCLUSIONS Patients appreciated the effects of interventions to reduce cancellations, because they increased their autonomy. Unanticipated consequences were that the telephone reminder created a personalized dialogue and centralization of surgical preparation and discharge processes improved continuity of care. Thus apart from improving surgical logistics, the pathway became more patient-centered.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Sogn og Fjordane University College, Postbox 1336851 Sogndal, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Christian von Plessen
- Department of Thoracic Medicine & Infectious Disease, Hillerød Hospital, Hillerød, Denmark
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kjell Haug
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Aslak Bjarne Aslaksen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Institute of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Oddbjørn Bukve
- Institute of Social Science, Sogn og Fjordane University College, Postbox 1336851 Sogndal, Norway
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Tagarakis GI, Voucharas C, Simopoulos V, Karangelis D, Daskalopoulos ME, Parisis C, Tsantilas A, Sataitidis I, Lampoura S, Vretzakis G, Tsilimingas NB. Why are thoracic operations postponed? J Cardiothorac Surg 2012; 7:31. [PMID: 22494485 PMCID: PMC3351366 DOI: 10.1186/1749-8090-7-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/11/2012] [Indexed: 11/13/2022] Open
Abstract
Aim To investigate and present the reasons that cause the postponement of thoracic surgical operations. Methods We retrospectively included in the study all patients submitted to elective thoracic surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule. Results 81 out of a total of 542 patients (14.9%) scheduled for elective thoracic operation had their procedure postponed. The reasons were mainly organisatory (in 42 cases, 51.85%), which in order of significance were: shortage in matching erythrocyte units, shortage in anaesthetic/nursing staff and unavailability in operating rooms. The rest of the cases (39, 48.1%) were postponed due to medical reasons, which in descending order of significance were: respiratory infections and exacerbations of COPD, cardiological problems, misregulation of antiplatelet/antithrombotic drugs and infections from other systems (gastrointestinal, urinary, etc.). Elderly male patients planned for major/oncologic surgery were most possible to have their operation postponed for medical reasons. Discussion-Conclusions Thoracic operations are postponed owed to organisatory as well as medical reasons, the latter mainly affecting elderly, morbid patients awaiting for major/oncologic surgery.
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Affiliation(s)
- Georgios I Tagarakis
- Department of Cardiovascular and Thoracic Surgery,, University of Thessaly, Larissa, Greece.
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Tagarakis GI, Karangelis D, Voucharas C, Daskalopoulos ME, Koufakis T, Mouzaki M, Lampoura S, Papadopoulos D, Sataitidis I, Tsilimingas NB. Why are heart operations postponed? J Cardiothorac Surg 2011; 6:106. [PMID: 21892932 PMCID: PMC3179942 DOI: 10.1186/1749-8090-6-106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 09/05/2011] [Indexed: 12/04/2022] Open
Abstract
Aim To investigate the reasons that lead to postponement of cardiac operations, in order to elucidate the problem and help patients through modes of prevention. Methods-Design We retrospectively included in the study all patients submitted to elective adult heart surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule. Results 94 out of a total of 575 patients (16.34%) scheduled for elective cardiac operation had their procedure postponed. The reasons were mainly organisatory (in 49 cases, 52.12%), which in order of significance were: unavailability in operating rooms, shortage in matching erythrocyte units and shortage in anaesthetic/nursing staff. The rest of the cases (45, 47.88%) were postponed due to medical reasons, which in order of significance were: febrile situations, including infections of the respiratory, gastrointestinal and urinary system, problems with the regulation of antiplatelet and antithrombotic drugs, neurological manifestations such as stroke and transient ischaemic attacks, exacerbation of asthma/chronic obstructive pulmonary disease, arrhythmias, renal problems and allergic reactions to drugs. Patients with advanced age and increased Euroscore values were most possible to have their heart operation postponed. Conclusions Heart operations are postponed due to organisatory as well as medical reasons, the latter mainly affecting older, morbid patients who therefore require advanced preoperative care.
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Affiliation(s)
- Georgios I Tagarakis
- Department of Cardiovascular and Thoracic Surgery, University of Thessaly, Larissa, Greece.
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Magnusson H, Felländer-Tsai L, Hansson MG, Ryd L. Cancellations of elective surgery may cause an inferior postoperative course: the ‘invisible hand’ of health-care prioritization? ACTA ACUST UNITED AC 2011. [DOI: 10.1258/ce.2011.011005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Elective surgery can be cancelled when resources are overwhelmed by emergency cases. We hypothesized that such cancellations, on psychological grounds, are followed also by inferior clinical results and we conducted a retrospective survey of patients following joint replacement surgery. Sixty patients having suffered from administrative cancellation prior to their operation during an 18-month period and with six months follow-up were identified and compared with another 60 matched patients after having the same type of surgery but without prior cancellation. All patients received questionnaires on complications and on visual analogue scale (VAS) assessment on subjective wellbeing and quality of life (QoL) at follow-up. The study group reported 50 complications versus 33 for controls ( P < 0.03). A borderline significant difference was found for myocardial infarction, 4 versus 0 ( P < 0.05). There was no difference in VAS registration and QoL measurements did not quite reach statistical significance ( P = 0.06). Cancellations (postponements) of elective surgery for administrative reasons may be followed by inferior clinical results, and this merits further prospective study.
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Affiliation(s)
- Håkan Magnusson
- Division of Orthopaedics, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, S-141 86 Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital/Huddinge, S-141 86 Stockholm, Sweden
| | - Li Felländer-Tsai
- Division of Orthopaedics, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, S-141 86 Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital/Huddinge, S-141 86 Stockholm, Sweden
| | - Mats G Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, P.O. Box 564, S-751 22 Uppsala, Sweden
| | - Leif Ryd
- Division of Orthopaedics, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, S-141 86 Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital/Huddinge, S-141 86 Stockholm, Sweden
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Bergvik S, Sørlie T, Wynn R. Approach and avoidance coping and regulatory focus in patients having coronary artery bypass graft surgery. J Health Psychol 2010; 15:915-24. [PMID: 20453051 DOI: 10.1177/1359105309359542] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Coronary artery bypass graft (CABG) surgery is stressful, and the patient's coping affects recovery and outcome. The aim of the study was to identify patients' thoughts and concerns, and explore the relevance of approach/avoidant coping and Regulatory Focus Theory (RFT). Nine patients were interviewed, using an interpretative phenomenological approach. The patients made use of various avoidant (e.g. neglecting symptoms, delaying help-seeking, avoiding thoughts) and approach strategies (e.g. persistent search for the diagnosis, mental preparation for surgery). RFT versus approach/avoidant coping is discussed. RFT may contribute to our understanding of motivational cognitions in patients' coping with illness and treatment.
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Affiliation(s)
- Svein Bergvik
- University of Tromsø & University Hospital of Northern Norway, Tromsø, Norway
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González-Arévalo A, Gómez-Arnau JI, delaCruz FJ, Marzal JM, Ramírez S, Corral EM, García-del-Valle S. Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia 2009; 64:487-93. [DOI: 10.1111/j.1365-2044.2008.05852.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sundaram K, Sankaran S, Amerally P, Avery C. Cancellation of elective oral and maxillofacial operations. Br J Oral Maxillofac Surg 2007; 45:656-7. [DOI: 10.1016/j.bjoms.2007.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2007] [Indexed: 11/29/2022]
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Carr E, Brockbank K, Allen S, Strike P. Patterns and frequency of anxiety in women undergoing gynaecological surgery. J Clin Nurs 2006; 15:341-52. [PMID: 16466484 DOI: 10.1111/j.1365-2702.2006.01285.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients' perspective, that may increase or decrease anxiety in the pre- and postoperative periods. BACKGROUND It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. METHOD The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. RESULTS State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. CONCLUSION This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. RELEVANCE TO CLINICAL PRACTICE Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.
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Affiliation(s)
- Eloise Carr
- Bournemouth University, Institute of Health and Community Studies, Bournemouth, Dorset, UK
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Abstract
BACKGROUND The aim of this project was to increase rates of day surgery, reduce elective surgical waiting lists, give patients a guaranteed date of surgery and improve operating theatre utilization. The guiding principle behind the project was to treat the administration of elective surgery as a separate business unit, distinct from emergency surgery. METHODS Elective surgical referrals for admission from throughout the Western Sydney Health Area Service were pooled. The procedure for surgical admissions was altered in three areas: (i) the use of a new booking and waiting list system administered by a dedicated nurse coordinator who generated the lists for surgery; (ii) restructuring the elective surgical operating sessions; and (iii) planning post-discharge care at the time of operation using model clinical pathways. RESULTS AND CONCLUSIONS During the project period, the number of the selected surgical procedures performed doubled. Fifty-seven per cent of patients were discharged on the day of surgery. Surgeons took less time to perform procedures. By the end of the trial period, waiting lists for the selected procedures were eliminated. Operating costs as evaluated by the Centre for Health Economics Research and Evaluation were reduced by 25%. The administrative changes to surgical admissions resulted in improved cost and patient throughput for elective surgical admissions with no adverse patient outcomes.
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Affiliation(s)
- N Singh
- Western Sydney Area Health Service, Westmead Hospital, Westmead, New South Wales, Australia.
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