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Spazzapan M, Javier P, Abu-Ghanem Y, Dryhurst D, Faure Walker N, Lunawat R, Nkwam N, Tasleem A. Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment. Int J Qual Health Care 2023; 35:7061817. [PMID: 36857374 PMCID: PMC10019125 DOI: 10.1093/intqhc/mzad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/15/2022] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Abstract
Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of 'lead-in' antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%-16%) patients were started on antibiotics each month, while another zero to two (0%-2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.
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Affiliation(s)
- Martina Spazzapan
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Pinky Javier
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Yasmin Abu-Ghanem
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - David Dryhurst
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Nicholas Faure Walker
- *Corresponding author. Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom. E-mail:
| | - Rahul Lunawat
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Nkwam Nkwam
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Ali Tasleem
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
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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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Koh WX, Phelan R, Hopman WM, Engen D. Cancellation of elective surgery: rates, reasons and effect on patient satisfaction. Can J Surg 2021; 64:E155-E161. [PMID: 33666393 PMCID: PMC8064262 DOI: 10.1503/cjs.008119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The cancellation of elective surgeries is a major problem that increases wait times, exacerbates costs and can negatively affect patients, both psychologically and physically. Our objectives were to investigate the reasons for cancellations across specialties at a single centre, to compare these reasons with previous data from the same centre between 2005 and 2009 and to examine how cancellations affected patients’ lives and views of the medical system in cases when the cancellations were potentially preventable. Methods Cancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic centre were retrospectively reviewed. We evaluated the rates and reasons for cancellation and interviewed a subset of patients whose surgery was cancelled for a potentially preventable reason (i.e., operating room running late, bed shortage, emergency case took place of scheduled surgery). Results Across 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons. Compared with the data collected previously for general, gynecological and urological procedures, cancellation rates increased from 8.1% to 11.8%. Although patients reported inconvenience, they were generally satisfied with the availability and the quality of the health care they received. Conclusion Consistent with the previous study, our data suggest that most cancellations occur because of administrative or structural processes that are potentially preventable. Targeting these processes may help to reduce cancellations for elective surgeries and thereby improve economic efficiency and patient outcomes.
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Affiliation(s)
- Wan Xian Koh
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Koh); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Phelan, Engen); and the Kingston General Health Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, Ont. (Hopman)
| | - Rachel Phelan
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Koh); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Phelan, Engen); and the Kingston General Health Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, Ont. (Hopman)
| | - Wilma M Hopman
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Koh); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Phelan, Engen); and the Kingston General Health Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, Ont. (Hopman)
| | - Dale Engen
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Koh); the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Phelan, Engen); and the Kingston General Health Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, Ont. (Hopman)
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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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Abate SM, Chekole YA, Minaye SY, Basu B. Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020; 26:55-63. [PMID: 34568611 PMCID: PMC7440086 DOI: 10.1016/j.ijso.2020.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cancellation of operation on the intended day of surgery affects the efficiency of Operation Room which incurs a significant financial loss for the patient, hospital, and health care cost of a country at large. This systematic and Meta-Analysis was intended to provide evidence on the global prevalence and determinants of case cancellation on the intended day of surgery. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from January 2010 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting prevalence and determinants were included. RESULTS A total of 1207 articles were identified from different databases with an initial search. Fort-eight articles were selected for evaluation after the successive screening. Thirty-three Articles with 306,635 participants were included. The Meta-Analysis revealed that the global prevalence of case cancellation on the intended day of surgery was 18% (95% CI: 16 to 20). The Meta-Analysis also showed that lack of operation theatre facility accounted for the major reason for cancellation followed by no attendant and change in medical condition. CONCLUSION The meta-analysis revealed that the prevalence of case cancellation was very high in low and middle-income countries and the majorities were avoidable which entails rigorous activities on operation theatre facilities, preoperative evaluation and preparation, patient and health care provider communications. REGISTRATION This Systematic Review and Meta-Analysis was registered in a research registry (researchregistry5746) available at https://www.researchregistry.com/browse-the-registry#home/.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Yigrem Ali Chekole
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Solomon Yimer Minaye
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, India
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Petrone B, Fakhoury J, Matai P, Bitterman A, Cohn RM, Lutsky L. Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics. Arthrosc Sports Med Rehabil 2020; 2:e83-e89. [PMID: 32368743 PMCID: PMC7190548 DOI: 10.1016/j.asmr.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. Results Patients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non–English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. Conclusions Increased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. Level of Evidence Level III, case-control study.
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Affiliation(s)
- Brandon Petrone
- Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York, U.S.A
| | - Jordan Fakhoury
- Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York, U.S.A
| | - Prashant Matai
- Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York, U.S.A
| | - Adam Bitterman
- Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York, U.S.A
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell, Plainview Hospital, Plainview, New York, U.S.A
| | - Larry Lutsky
- Krasnoff Quality Management Institute, New Hyde Park, New York, U.S.A
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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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Ruohoaho UM, Toroi P, Hirvonen J, Aaltomaa S, Kokki H, Kokki M. Implementation of a 23-h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction. BJS Open 2020; 4:391-399. [PMID: 32109004 PMCID: PMC7260407 DOI: 10.1002/bjs5.50267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/01/2020] [Accepted: 01/19/2020] [Indexed: 02/03/2023] Open
Abstract
Background The 23‐h surgery model consists of elective operative care with an overnight hospital stay for patients unsuitable for day case surgery. The aim of this study was to assess the success of the 23‐h surgery model. Methods This was a prospective follow‐up study of patients undergoing surgery with the planned 23‐h model in a tertiary‐care university hospital during a 12‐month period 2 years after the model was implemented. Patients were interviewed 2 weeks after surgery, and the hospital operative database and patient records were searched. The primary outcome was the success of the process, defined as discharge before 10.00 hours on the first morning after surgery. Secondary outcomes were 30‐day readmission and reoperation rates, adverse events, and patient satisfaction with the process. Results Between May 2017 and May 2018, 993 adult patients underwent surgery with the 23‐h model, of whom 937 adhered to the model as planned (success rate 94·4 per cent). Gynaecological, gastrointestinal and orthopaedic surgery were the three most common surgical specialties. The surgical process was changed to an in‐hospital model for 45 patients (4·5 per cent), and 11 (1·1 per cent) were discharged on the day of surgery. The readmission rate was 1·9 per cent (19 of 993), and five patients (0·5 per cent) had a reoperation within 30 days of surgery. Fifty‐nine adverse events were noted in 53 patients (5·3 per cent), most commonly infection. Patient satisfaction was a median of 6–7 (maximum 7) points for various aspects of the model. Conclusion The success rate and patient satisfaction for the 23‐h surgery model was
high.
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Affiliation(s)
- U-M Ruohoaho
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - P Toroi
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - J Hirvonen
- Controller Unit, Kuopio University Hospital, Kuopio, Finland
| | - S Aaltomaa
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - H Kokki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - M Kokki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
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Hänninen-Khoda L, Koljonen V, Ylä-Kotola T. Patient-related reasons for late surgery cancellations in a plastic and reconstructive surgery department. JPRAS Open 2018; 18:38-48. [PMID: 32158836 PMCID: PMC7061671 DOI: 10.1016/j.jpra.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022] Open
Abstract
Late cancellations of scheduled operations cause direct and indirect costs for a hospital and economic and emotional stress for the patient. Previously, late cancellation rates for scheduled operations in plastic surgery have been shown to be attributable to patient-related causes in the majority of cases. In this retrospective study, we sought to examine specifically the patient-related reasons for the late cancellations in a plastic surgery operating theatre at Helsinki University Hospital in Finland from 2013 to 2014. We calculated latency between the date of decision for surgery and the scheduled operation day. In cases where the surgery was rescheduled and performed before 31 December 2015, the rescheduled waiting time latency was calculated. We aimed to improve our knowledge of the causes of late cancellations to further optimise the operating theatre efficiency and propose a strategic algorithm to avoid late cancellations During the study period, 327 (5.5%) of all the scheduled operations were recorded as late cancellations. Of these, 45.3% were because of patient-related issues. Acute infection, change in medical condition not noticed before and operation no longer necessary were by far the most common causes of cancellation, comprising 63.5%. Sixty-six per cent of patient-related cancelled operations were performed later, especially when the specific reason was patient's acute illness. Root-cause analysis shows that most of the underlying reasons for the cancellations can be attributed to a failure in communication. The majority of these cancellations were considered to be preventable, thus emphasising the importance of communication and skilful multi-professional planning of the operating theatre list.
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Affiliation(s)
- Liisa Hänninen-Khoda
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuija Ylä-Kotola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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10
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Desta M, Manaye A, Tefera A, Worku A, Wale A, Mebrat A, Gobena N. Incidence and causes of cancellations of elective operation on the intended day of surgery at a tertiary referral academic medical center in Ethiopia. Patient Saf Surg 2018; 12:25. [PMID: 30154916 PMCID: PMC6109985 DOI: 10.1186/s13037-018-0171-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Elective surgical case cancellation refers to any elective surgical case that is the list on the day prior to surgery but not operated upon as scheduled. Case cancellation has a major cause of psychological trauma to patients and their families. Despite little is known in Ethiopia. Therefore, this study aimed to assess incidence and reasons of cancellations of elective operation on the intended day of surgery at tertiary referral academic medical center in Ethiopia. Methods A prospective hospital-based cross-sectional study design was conducted in a tertiary referral academic medical center in Ethiopia among 146 participants. A self-administered questionnaire with an observatory checklist was used for collecting data from the anesthetist, nurse, and surgeons. Result In this study, 462 patients were scheduled for elective surgical operations. Among those, nearly almost one-third 146 (31.6%) of the operations were cancelled and 316 (68.4%) patients were operated on their planned date. The most common reason for cancellation were surgeon related (35.8%), patient related (28.7%), management related (21.2%) and anesthesia related factors (14. 4%). The cancellation was mainly due to improper scheduling (20.5%%), unavailability of surgeons (8.9%), unavailability of oxygen and blood (8%) and equipment (5.5%). Orthopedic (28.8%) and general surgery (17.1%) were the commonest cancelled cases. Conclusion The cancellation rate in our academic medical center remains high. Improper scheduling, unavailability of surgeons, medical illness, and unavailability of operating room equipment were the commonest reason for the cancellation of elective operation. Most cancellations were preventable. For this, proper preoperative assessment, proper scheduling, fulfilling necessary operating room equipment's and cross-matched blood by the hospital and other stakeholders, early clear communication with operating room team like surgeons was recommended.
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Affiliation(s)
- Melaku Desta
- 1College of Health Science, Department of midwifery, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Addissu Manaye
- 2College of medicine and Health Science, Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
| | - Abiot Tefera
- 2College of medicine and Health Science, Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
| | - Atalay Worku
- 2College of medicine and Health Science, Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
| | - Alemitu Wale
- 2College of medicine and Health Science, Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
| | - Alemlanchi Mebrat
- 2College of medicine and Health Science, Department of Anesthesia, Hawassa University, Hawassa, Ethiopia
| | - Negesso Gobena
- 3College of Medicine and Health Sciences, Lecturer and Senior Anesthetist, Hawassa University, Hawassa, Ethiopia
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Kaddoum R, Fadlallah R, Hitti E, El-Jardali F, El Eid G. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res 2016; 16:259. [PMID: 27412041 PMCID: PMC4944432 DOI: 10.1186/s12913-016-1475-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background Cancellation of elective scheduled operations on the day of surgery leads to an inefficient use of operating room (OR) time and a waste of resources. It also causes inconvenience for patients and families. Moreover, day of surgery (DOS) cancellation creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations as well as opportunity costs of lost time and missed income. The objective of this study is to establish the rate of elective surgical cases cancellations on the day of surgery and the reasons for these cancellations stratified by avoidable versus unavoidable within a tertiary care teaching hospital in Beirut, Lebanon as well as recommend appropriate solutions. Method This is a prospective audit of the operation theatre list over a period of eight months (January 1, 2013-August 30, 2013). All patients scheduled to undergo elective surgeries at the hospital from January-August 2013 were included. An assigned OR staff recorded the cancelled cases in real time. The assigned staff confirmed the cancellation reason and added additional explanation if necessary by calling patients or through direct inquiry of clerical and/or clinical staff the following day. A Pareto chart was constructed to prioritize the reasons that accounted for 80 % of the avoidable surgical cancellations. Results For the given study period, 5929 elective surgeries were performed, of which 261 cases (4.4 %) were cancelled on the day of surgery. 187 cases (or 71.6 %) were judged as potentially avoidable cancellations versus 74 (28.4 %) that were judged as unavoidable. Of the 187 potentially avoidable cancellations, lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and OR behind schedule accounted for almost 80 % of the causes. Conclusion This study showed that the majority of cancellations were deemed avoidable and hospital related. A day of surgery cancellation rate less than 2 % is attainable. Determining the major avoidable contributors to DOS cancellations is an essential first step to developing appropriate interventions to improve operating theater efficiency. Recommended interventions were presented accordingly.
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Affiliation(s)
- Roland Kaddoum
- Deparment of Operating Room, American University of Beirut Medical Center, Beirut, Lebanon
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghada El Eid
- Department of the Chief Medical Officer, American University of Beirut Medical Center, Beirut, Lebanon.
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Fayed A, Elkouny A, Zoughaibi N, Wahabi HA. Elective surgery cancelation on day of surgery: An endless dilemma. Saudi J Anaesth 2016; 10:68-73. [PMID: 26955314 PMCID: PMC4760047 DOI: 10.4103/1658-354x.169479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Cancelation of surgery is a constant agonizing dilemma for nearly all healthcare services that has been intensively investigated to find out its roots, consequences, and possible solutions. The rates of cancelation of surgery vary between centers and more so among surgical specialties with numerous reasons standing behind this phenomenon. Patients and Methods: In the current study, analysis of monthly cancelation rates from January 2009 to December 2012, and assessment of establishing new operating rooms (ORs) using statistical process control charts was conducted. A detailed review of a total of 1813 cases canceled on the day of surgery from January to December 2012, to examine the various reasons of cancelation among surgical specialties. Results: The average cancelation rate was 11.1%, which dropped to 9.0% after launching of new theaters. Four reasons explained about 80% of cancelations; Patients “no show” was the leading cause of cancelation (27%). One-fourth of cancelations (24.3%) were due to the need for further optimization, and the third most prominent cause of cancelation was a lack of OR time (19.5%). Unavailability of staff/equipment/implants accounted for only 0.7% of cancelations. The no show was the most common cause of cancelation among all surgical specialties ranging from 21% for plastic surgery to 32% in ophthalmic surgeries. Conclusion: It was confirmed that there is a unique profile of cancelation of surgery problem for every institute, an extension of infrastructure may not be the only solution. Control charts helped to enhance the general picture and are functional in monitoring and evaluating changes in the cancelation of surgery.
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Affiliation(s)
- A Fayed
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt; College of Medicine, Princess Norah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - A Elkouny
- Department of Anaesthesia, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - N Zoughaibi
- Department of Anaesthesia, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; Sheikh Bahamdan Research Chair of Evidence-based Healthcare and Knowledge Translation, College of Medicine, Riyadh, Kingdom of Saudi Arabia
| | - H A Wahabi
- Chair of Evidence Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Olson RP, Dhakal IB. Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit. Perioper Med (Lond) 2015; 4:12. [PMID: 26664719 PMCID: PMC4674935 DOI: 10.1186/s13741-015-0022-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Structured preoperative assessment has been reported to improve operating room efficiency as measured by metrics such as day of surgery cancellations (DOSCs). However, not all patients require comprehensive assessment; routine full assessments can result in unnecessary duplication of tests and investigations. Selective nurse screening under the supervision of anesthesiology may provide adequate information gathering in lower risk patients. This study is undertaken to assess if DOSC rates vary with different assessment processes. Methods At a single academic tertiary care hospital, from Jan 2 to May 31, 2013, the consecutive patients undergoing comprehensive preoperative assessment (CPA) and nurse screening (NS), as well as the patients not assessed by the anesthesiology-supervised preoperative process, were followed for the occurrence and reason for DOSC. The operating room schedule of all elective surgery patients was analyzed to allow calculation of rates of DOSCs. Reasons for cancellations were documented as one of ten structured reasons by preoperative holding area clerical staff. Results Overall, there were 14,893 elective surgery patients in this time period, with 183 DOSCs, giving a rate of 1.23 % (95 % CI 1.06, 1.42). Patients who received CPA numbered 5980; 29 of them had a DOSC, giving a rate of 0.48 % (95 % CI 0.33–0.70) (P < 0.0001 vs. no assessment). Patients receiving NS numbered 1840; 11 of them had a DOSC, giving a rate of 0.60 % (95 % CI 0.30–1.10) (P < 0.0001 vs. no assessment). The most common reason for cancellation was new medical condition. Conclusions A very low DOSC rate can be achieved with a comprehensive preoperative process where some patients are selectively telephone screened by nurses, with complete assessment deferred to the anesthesiologist on the day of surgery.
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Affiliation(s)
- Ronald P Olson
- Department of Anesthesiology, Duke University Medical Center, Box 3094, 40 Duke Medicine Circle Dr, Durham, NC 27710 USA
| | - Ishwori B Dhakal
- Department of Anesthesiology, Duke University Medical Center, Box 3094, 40 Duke Medicine Circle Dr, Durham, NC 27710 USA
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An audit of operating room time utilization in a teaching hospital: is there a place for improvement? ISRN SURGERY 2014; 2014:431740. [PMID: 25006514 PMCID: PMC3976892 DOI: 10.1155/2014/431740] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
Aim. To perform a thorough and step-by-step assessment of operating room (OR) time utilization, with a view to assess the efficacy of our practice and to identify areas of further improvement. Materials and Methods. We retrospectively analyzed the most ordinary general surgery procedures, in terms of five intervals of OR time utilization: anaesthesia induction, surgery preparation, duration of operation, recovery from anaesthesia, and transfer to postanaesthesia care unit (PACU) or intensive care unit (ICU). According to their surgical impact, the procedures were defined as minor, moderate, and major. Results. A total of 548 operations were analyzed. The mean (SD) time in minutes for anaesthesia induction was 19 (9), for surgery preparation 13 (8), for surgery 115 (64), for recovery from anaesthesia 12 (8), and for transfer to PACU/ICU 12 (9). The time spent in each step presented an ascending escalation pattern proportional to the surgical impact (P = 0.000), which was less pronounced in the transfer to PACU/ICU (P = 0.006). Conclusions. Albeit, our study was conducted in a teaching hospital, the recorded time estimates ranged within acceptable limits. Efficient OR time usage and outliers elimination could be accomplished by a better organized transfer personnel service, greater availability of anaesthesia providers, and interdisciplinary collaboration.
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Affiliation(s)
- Martin Schuster
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Fürst-Stirum-Klinik Bruchsal, Academic Teaching Hospital, University of Heidelberg, Bruchsal, Germany
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