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Adesina OA, Ojikutu R, Opaleye T, Adesina OO, Idowu OS, Adebayo OK, Ojeriakhi OJ. Cancellation of Elective Oral and Maxillofacial Surgery, a Tertiary Hospital Experience. J Maxillofac Oral Surg 2024; 23:436-441. [PMID: 38601227 PMCID: PMC11001818 DOI: 10.1007/s12663-023-02002-6] [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: 11/24/2022] [Accepted: 08/16/2023] [Indexed: 04/12/2024] Open
Abstract
Background Cancellation of elective surgery is said to occur when a patient's name appears on the operation list, but the operation is not done on the intended date. Cancelling elective surgeries is a long-standing problem faced by many countries worldwide. Reasons for cancellation of surgery vary from one hospital to another. The goal of this study was to identify factors associated with the cancellation of scheduled Oral and maxillofacial surgeries in the Lagos State University Teaching Hospital. Methodology Cancellations of elective scheduled operations from January 2021 to July 2022 were reviewed retrospectively. All cancellations were recorded in a predesigned form which included information about the age of the patient, hospital identification number, date of cancellation, type of operation, the Surgeon and the Anaesthetist, preoperative anaesthetic evaluations, any associated medical problems and the presumed reasons for cancellations for in-patients and day case surgery. Patients who died before the time of their scheduled surgery were excluded. Result 80 patients had their operation cancelled on the day of surgery, and the rate of cancellations was 44.2%. The most common causes of cancellations were patient-related (50%), accounting for up to half of the cancellations. The major reason for cancellation under the administrative category was insufficient time in the theatre to complete the operation list (18.8%). Financial constraint (16.3%) on the day of the surgery was noted more among planned day case procedures and delayed laboratory results (12.5%); oftentimes, covid test results were the major reasons for cancellations under the patient-factors category. Conclusion The rate of cancellation in this study was high, most of which are patients related. Administrative-related reasons were also identified. However, in most cases, these cancellations can be avoided.
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Affiliation(s)
- Oluwafemi Adewale Adesina
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, PMB 21005, Ikeja, Lagos State Nigeria
| | - Rasheedat Ojikutu
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, PMB 21005, Ikeja, Lagos State Nigeria
| | - Taofiq Opaleye
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, PMB 21005, Ikeja, Lagos State Nigeria
| | | | - Omobolaji Stephen Idowu
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, PMB 21005, Ikeja, Lagos State Nigeria
| | - Olayinka Kuburat Adebayo
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, PMB 21005, Ikeja, Lagos State Nigeria
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Reuter S, Schmalfeldt B, Haas SA, Zapf A, Cevirme S, Prieske K, Wölber L, Müller V, Zöllner C, Jaeger A. Impact of Introducing a PACU24 Concept on the Perioperative Outcome of Patients with Advanced Ovarian Cancer Treated with Cytoreductive Surgery. Geburtshilfe Frauenheilkd 2023; 83:1022-1030. [PMID: 37588253 PMCID: PMC10427201 DOI: 10.1055/a-2055-9349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/15/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort. Methods A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and after (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary. Results The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p = 0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p < 0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU). Summary Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.
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Affiliation(s)
- Susanne Reuter
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian A. Haas
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Antonia Zapf
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sinan Cevirme
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Prieske
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Jaeger
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Jindal R, Patel P, Lakhera KK, Gulati C, Singh S, Sharma RG. Assessment of Operative Time for Lip and Oral Cancers: A Tool to Improve Operative Room Efficiency. Indian J Otolaryngol Head Neck Surg 2023; 75:219-226. [PMID: 37274995 PMCID: PMC10235003 DOI: 10.1007/s12070-022-03135-9] [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: 04/06/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Operation theatre (OT) time utilisation rates can be improved with an assessment of the procedure time that will result in effective scheduling of cases. Our study is the first of its kind to audit the amount of OT time required for a particular surgery in lip and oral cavity cancers, depending on the various components of this complex procedure. This prospective cross-sectional study, based on an operative room database of 323 OT sessions, was conducted in the Department of Surgical Oncology at a tertiary care centre on lip and oral cancer patients from January 1st, 2019 to December 31st, 2020. Various components of the surgery, like the primary site, operating surgeon, type of neck dissection, bone resection, and reconstructive procedure, were noted. The time of entry and exit of the patient from the OT was noted. Operative time and OT time utilisation rates were calculated. SPSS 21.0 statistical tool; Students 'T', ANOVA and Games-Howell tests were applied. In 323 OT sessions, while 303 surgeries were done for primary cases (93.8%), the remaining 20 cases were for recurrent cases (6.2%). Buccal mucosa and the floor of the mouth were the most and least common sites, respectively. The mean OT time was 212.42 ± 73.83 min, the maximum being the primary at alveolus. The mean OT late start time was 70.03 ± 23.41 min and the mean OT runover time was 37.62 ± 43.53 min. The mean time varied significantly with the type of neck dissection, bone resection, and reconstructive surgery done and the operating surgeon. The mean OT time was highest for free flap reconstructive surgery (328.71 ± 62.02 min), but it didn't vary with its type. Considering only the lip and oral cancer surgeries, the OT time utilisation rate was 57.1%. Assessment and quantification of the operative duration of lip and oral cancer surgeries will help in accurate prediction of surgical duration, better OT list planning, and thus improved OT time utilisation rate. Our research not only provides data on the historical mean of procedures, but it may also encourage other centres to adopt our quantitative approach to OT scheduling.
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Affiliation(s)
- Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Pinakin Patel
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Kamal Kishor Lakhera
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Chanchal Gulati
- Department of Anaesthesiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Suresh Singh
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan India
| | - Raj Govind Sharma
- Department of Surgical Oncology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India
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Laudanski K, Wain J, Pizzini MA. An In-Depth Analysis of Providers and Services of Cancellation in Anesthesia Reveals a Complex Picture after Systemic Analysis. Healthcare (Basel) 2023; 11:healthcare11030357. [PMID: 36766932 PMCID: PMC9914780 DOI: 10.3390/healthcare11030357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
Abstract
The variances in operating room (OR) cancellation rates between different service lines and operators within these service lines were assessed by reviewing the electronic medical record (EMR) covering 34,561 cases performed by 199 OR operators in 2018. We assumed that cancellations would differ between different service lines, but the between-operators variance was minimal within the service line. We hypothesized that most variability would be secondary to patient-specific (weekdays, time of year, and national holidays), seasonal and administrative issues. Of 4165 case cancellations, the majority (73.1%) occurred before the patient arrived at the hospital. A total of 60% of all cancellations were within gastroenterology, interventional cardiology, and orthopedics. Cancellation rate variability between surgeons operating within the same service line greatly varied between services from very homogenous to very diverse across providers. The top reasons for cancellation were: date change, canceled by a patient, or "no show". The highest cancellation rates occurred on Mondays and Tuesdays, in January and September, and during weeks associated with national holidays. In summary, cancellation variability must be analyzed at the level of individual specialties, operators, and time variability.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-(815)-483-4779
| | - Justin Wain
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA
| | - Mark-Alan Pizzini
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Ow RA, Shotts S, Kakarlapudi V, McIntyre J, Naclerio RM, You C, Pappas A, Brayton L, Kuang Y, Shao J. Pharmacokinetic Evidence of Steady and Sustained Drug Release from Long-Acting Implantable Corticosteroid Matrices for Chronic Rhinosinusitis. Am J Rhinol Allergy 2022; 36:733-740. [PMID: 35708181 PMCID: PMC9549255 DOI: 10.1177/19458924221107200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The efficacy of topical corticosteroids is limited in chronic rhinosinusitis
(CRS) due to rapid clearance from the nasal cavity and insufficient drug
delivery to inflamed sinonasal passages. LYR-210 is an implantable
corticosteroid matrix designed to provide up to 24 weeks of treatment to
patients with CRS by locally delivering mometasone furoate (MF) to the
sinonasal mucosa. In a randomized, controlled, dose-ranging LANTERN study,
LYR-210 (7500 µg) achieved clinically relevant improvement in CRS cardinal
symptom composite scores, the 22-item Sinonasal Outcome Test (SNOT-22),
ethmoid opacification, and the need for rescue treatment at 24 weeks. Objective As the plasma MF concentrations of LYR-210 (2500 µg) and LYR-210 (7500 µg)
were evaluated at weeks 4, 12, and 24 in the LANTERN study (data on file at
Lyra Therapeutics, Inc.), this study aims to characterize the
pharmacokinetic profiles of both doses of LYR-210 at earlier timepoints
post-placement in patients with CRS. Methods Twenty-four surgically naïve adult patients with CRS were enrolled in an
open-label, multicenter study and underwent in-office bilateral
administration of LYR-210 (2500 µg) (n = 12 patients) or
LYR-210 (7500 µg) (n = 12 patients) into the middle meatus.
Plasma MF concentrations were determined pre-placement and 1-h
post-placement (day 1), and on days 2, 3, 7, 14, 21, 28, 42, and 56 by
liquid chromatography-tandem mass spectrometry. Results Both LYR-210 doses were well-tolerated with no serious adverse events.
Systemic MF levels were dose-dependent and lower than reported values of
other respiratory MF products. Plasma MF concentrations showed steady drug
release from LYR-210 (2500 µg) and LYR-210 (7500 µg) that persisted through
day 56. Conclusion LYR-210 achieved dose-dependent, continuous local MF delivery at a steady
rate with low systemic exposure for months.
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Affiliation(s)
- Randall A Ow
- Sacramento Ear, Nose, and Throat, Roseville, California
| | | | | | | | | | | | | | | | - Yina Kuang
- Lyra Therapeutics, Inc., Watertown, Massachusetts
| | - James Shao
- Lyra Therapeutics, Inc., Watertown, Massachusetts
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Lee KJ, Kim J, Kim Y, Yang E, Yun KR, Kim SH. Analysis of the reasons why patients cancel shoulder surgery despite recommendation. Clin Shoulder Elb 2022; 25:121-128. [PMID: 35698781 PMCID: PMC9185113 DOI: 10.5397/cise.2021.00689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background To determine the reasons and factors that contribute to the cancellations of shoulder surgeries at a tertiary referral center and to analyze the characteristics of these patients. Methods Patients scheduled for shoulder surgery from June 2017 to July 2019 were allocated to a surgery group (n=224) or a cancellation group (n=96). These groups were compared with respect to patient characteristics, types of surgery, distance from patient’s home to the hospital, traveling time to the hospital, and waiting period before surgery. Reasons for cancellation and responses were acquired using a telephone interview and were subsequently analyzed. Results The cancellation group was older, had a less frequent history of trauma, and had a lower proportion of patients undergoing arthroscopic rotator cuff repair than the surgery group (p=0.009, p=0.014, and p=0.017, respectively). In addition, mean distance from the patients’ homes to the hospital and preoperative waiting time were both longer in the cancellation group (p=0.001 and p<0.01, respectively). The most common reason given for cancellation was another medical condition (28.1%). Conclusions Older age, need for arthroscopic rotator cuff repair surgery, longer distance from the patient’s home to the hospital, and longer waiting period significantly increased the chance of cancellation. The main reason for canceling surgery was a concurrent medical condition. Therefore, identification of other medical conditions in advance is an important consideration when surgeons recommend shoulder surgery to patients. Surgeons should also consider patient's age, type of surgery, distance from the hospital, and waiting time when assessing the possibility of surgery cancellation.
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Cima J, Almeida Á. The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:95-104. [PMID: 34304324 PMCID: PMC8310557 DOI: 10.1007/s10198-021-01354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Equity in access to scheduled surgery has been a topic of attention of researchers and decision-makers on healthcare. Most studies analyse the number of days that patients wait before undergoing surgery, and ignore patients that have been on the waiting list but have not benefited from surgery. This study contributes to the existing literature on waiting lists by analysing cancellations along with surgery episodes. METHODS We use a database comprising all patients that entered the waiting list for scheduled surgeries in the Portuguese National Health Service from 2011 to 2015 (around 3 million observations) and estimate survival models to explain waiting times, where cancellations are introduced as censored data. RESULTS The cancellation rate is significant (around 14%), and has a considerable impact on results: ignoring cancellations biases estimates, in particular for gender differences (that are overestimated without cancelations), and for the age effect (that is underestimated). CONCLUSION Thus, our approach provides a more accurate understanding of the impact that several factors have on overall access to scheduled surgery.
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Affiliation(s)
- Joana Cima
- Faculdade de Economia, Universidade Do Porto, 4200-464 Porto, Portugal
| | - Álvaro Almeida
- CEF.UP and Faculdade de Economia, Universidade Do Porto, Porto, Portugal
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Milliren CE, Lindsay B, Biernat L, Smith TA, Weaver B. Can digital engagement improve outcomes for total joint replacements? Digit Health 2022; 8:20552076221095322. [PMID: 35493958 PMCID: PMC9044791 DOI: 10.1177/20552076221095322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Patient activation and engagement can improve outcomes of medical and surgical care by increasing involvement of patients in their care plan. We designed a digital engagement tool to improve surgical cancellation and post-surgical outcomes for adult patients undergoing total joint replacements by providing patient education materials via email or text, in small increments throughout the perioperative period. Methods We assessed the tool's impact using a quasi-experimental design comparing patients scheduled for surgery January–June 2017 (pre-intervention) versus January–June 2018 (post-intervention). Post-intervention patients with digital contact information in the medical record were automatically enrolled. We extracted de-identified administrative data for all patients during both time periods and utilized an intent-to-treat approach including all post-intervention patients regardless of enrollment. Surgical cancellation and post-surgical outcomes (length of stay, discharge to home and revisits and readmissions) were compared between periods using adjusted regression models. We also examined associations between measures of engagement with the intervention and outcomes. Results A total of 2027 joint replacement patients were included (720 hip replacements; 1307 knee replacements). Adjusting for gender, age and insurance type, both hip and knee patients in the post-intervention group were more likely to have a cancelled surgery, but cancellations were less likely to be on the day of surgery compared to pre-intervention patients. Post-intervention patients were also less likely to have length of stay >2 days. Forty- three per cent of hip and 47% of knee patients in the post-period received the intervention and most were highly engaged. Higher engagement was associated with lower odds of surgical cancellation, shorter stays and higher odds of discharge home. Conclusion Findings suggest that utilization of a digital patient engagement tool translates into improved hospital efficiency and patient outcomes, particularly for those highly engaged.
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Affiliation(s)
- Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | | | - Lisa Biernat
- HealthEast, now a part of M Health Fairview, St. Paul, MN, USA
| | - Todd A Smith
- HealthEast, now a part of M Health Fairview, St. Paul, MN, USA
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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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10
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Demilew BC, Yisak H, Terefe AA. Magnitude and causes of cancelation for elective surgical procedures in Debre Tabor General hospital: A cross-sectional study. SAGE Open Med 2021; 9:20503121211003357. [PMID: 33796304 PMCID: PMC7975488 DOI: 10.1177/20503121211003357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Elective surgical case cancelation is a common problem and can cause
prolonged wait times, harm to patients, and is a waste of scarce resources.
Reasons for cancelations are complex and change place to place because they
are related to patients, organizational issues, and clinical staff. So, this
study is aimed to assess the magnitude and causes of the case cancelation
among elective surgical cases in a general hospital. Methods: A cross-sectional prospective study design was conducted on 221 patients
scheduled for elective surgery from March 1 to May 30 2019 G.C. All
consecutive elective surgical cases scheduled during the study period were
included in the study. Data were collected using prepared and pretested
questionnaire and entered in the SPSS version 20 for analysis purpose. Results: During the study, 221 patients were scheduled for elective surgical
operations, among these 150 (67.9%) patients were operated on the planned
date of surgery whereas 71 (32.1%) operations were canceled. The decision
for the cancelation was done by the anesthetist due to preoperative
coexisting disease findings and inadequate preparation of the patient for
the intended operations were 33 (46.5%) followed by administrative-related
issues which account 26 (36.6%). Conclusion: Cancelation of elective surgical procedures on the day of surgery was high in
this study due to different reasons. Cancelation can be minimized if all the
responsible bodies can communicate early regard to the patient.
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Affiliation(s)
- Basazinew Chekol Demilew
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Yisak
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Agazhe Aemiro Terefe
- Department of Medical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Llanos S, Galán-Olleros M, Manrique E, Celada R, Galeote J, Marco F. Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Al Ghunimat A, Hind J, Abouelela A, Sidhu GAS, Lacon A, Ashwood N. Communication With Patients Before an Operation: Their Preferences on Method of Communication. Cureus 2020; 12:e11431. [PMID: 33324514 PMCID: PMC7732730 DOI: 10.7759/cureus.11431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background With the constantly evolving communication technologies, it is essential for all healthcare professionals to try utilising various methods in communicating with patients. This will lead to better healthcare outcomes and patient satisfaction. Objective The aim of the study was to compare a patient's preference to various communication methods regarding their appointments and to evaluate if we're giving our patients an appropriate notice period prior to their operation. Methods A questionnaire was given to 111 patients who underwent elective orthopaedic procedures. Results Factors like age and gender affect the choice of communication method. Traditional letters still have a role for an older population aged 65 and over. However, younger patients showed higher preference for other communication methods such as phone calls, texts, and e-mails. Gender also had a role in choosing a preference where male patients chose a range of options whilst female patients preferred phone calls. Most patients stated they received an appropriate notice period, with 88% of patients stating they would like to be notified one-two weeks prior to their operation. Conclusion More research needs to be conducted into using text messages and e-mails in communicating with elective surgical patients, in addition to implementing newer technologies like mobile phone applications and secure online messaging portals, as this has the potential to reshape the communication process with our patients and lead to better health outcomes and patient satisfaction.
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Affiliation(s)
- Abdallah Al Ghunimat
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Jamie Hind
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Amr Abouelela
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Gur Aziz Singh Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Andrew Lacon
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, GBR
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Llanos S, Galán-Olleros M, Manrique E, Celada R, Galeote JE, Marco F. Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:75-84. [PMID: 33177010 DOI: 10.1016/j.recot.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). MATERIAL AND METHODS Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. RESULTS We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. CONCLUSIONS The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.
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Affiliation(s)
- S Llanos
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - M Galán-Olleros
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - E Manrique
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - R Celada
- Servicio de Admisión y Documentación clínica. Hospital Clínico San Carlos, Madrid, España
| | - J E Galeote
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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Batt J, Cook N, Nadeem M, Sahu A. Dilutional local anaesthetic techniques in oncoplastic breast surgery and potential benefits during the COVID-19 pandemic and beyond. J Perioper Pract 2020; 30:277-282. [PMID: 32869726 DOI: 10.1177/1750458920944080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION COVID-19 has changed the approach to operating on breast cancer for the benefit of patients, staff and the general population. One approach involves the switch from operating under general to local anaesthetic. We assess whether diluational local anaesthetic is as effective as the current standard approach. METHODS Postoperative pain was recorded in prospective, consecutive patients undergoing wide local excision under dilutional local anaesthetic (concentration < 1mg/ml). Pain scores were documented at 0, 30 and 60 minutes and compared to a control group consisting of combined general with local anaesthetic. RESULTS Pain significantly increased in the control group during the postoperative recovery. This was not seen in the dilutional local anaesthetic group that was non-inferior to the standard approach at 0, 30 and 60 minutes. CONCLUSION Dilutional local anaesthetic provides a safe and effective alternative approach to operating on breast cancer patients whilst avoiding risky general anaesthetic in a COVID-19 pandemic environment.
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Affiliation(s)
- Jeremy Batt
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Nicola Cook
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Muhammad Nadeem
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
| | - Ajay Sahu
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury-On-Trym, UK
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Yıldız Altun A, Özer AB, Turhan Aksoku B, Karatepe Ü, Kilinç M, Erhan ÖL, Demirel İ, Bolat E. Evaluation of the Reasons for the Cancellation of Elective Procedures at Level 3 University Hospital on the Day of Surgery. J Perianesth Nurs 2020; 35:514-517. [PMID: 32402774 DOI: 10.1016/j.jopan.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/14/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE Unexpected cancellations of planned elective procedures are a global problem for hospitals, causing a waste of hospital resources and manpower, and reduces the efficiency of hospitals. In this study, we tried to identify the causes of cancellations of elective procedures, and to examine the relationship between the causes. DESIGN A retrospective, descriptive single-center study. METHODS Nine thousand five hundred sixty-six elective procedures scheduled between January 2015 and December 2015 were retrospectively examined. Reasons for cancellation, the associated surgical clinic, and the day and season of the canceled procedures were recorded. FINDINGS Of the total 9,566 procedures, 496 (5.2%) were canceled. Of the cancellations, 31.3% were due to patient-related reasons, 29.2% because of inadequate anesthesia preparation, and 19% because of nonavailability of operating rooms. CONCLUSIONS Cancellation of elective surgeries causes a waste of time and resources. Determining the reasons for cancellations to reduce cancellation rates is important for each hospital.
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Affiliation(s)
- Aysun Yıldız Altun
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey.
| | - Ayşe Belin Özer
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Malatya, Turkey
| | | | - Ümit Karatepe
- Department of Anaesthesiology and Reanimation, Fethi SEKİN State Hospital, Elazığ, Turkey
| | - Mikail Kilinç
- Department of Anaesthesiology and Reanimation, Doğu Anadolu Private Hospital, Elazığ, Turkey
| | - Ömer Lütfi Erhan
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - İsmail Demirel
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Esef Bolat
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
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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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17
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Felbaum DR, Stewart JJ, Anaizi AN, Sandhu FA, Nair MN, Voyadzis JM. Implementation and Evaluation of a Smartphone Application for the Perioperative Care of Neurosurgery Patients at an Academic Medical Center: Implications for Patient Satisfaction, Surgery Cancelations, and Readmissions. Oper Neurosurg (Hagerstown) 2019; 14:303-311. [PMID: 28541569 DOI: 10.1093/ons/opx112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 04/11/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smartphone applications (apps) in the health care arena are being increasingly developed with the aim of benefiting both patients and their physicians. The delivery of adequate instructions both before and after a procedure or surgery is of paramount importance in ensuring the best possible outcome for patients. OBJECTIVE To demonstrate that app-based instructions with built-in reminders may improve patient understanding and compliance and contribute to reducing the number of surgery cancellations and postoperative complications and readmissions. METHODS We prospectively accrued 56 patients undergoing routine neurosurgery procedures who subsequently downloaded the app. The median age was 54 (range 27-79). Patients were followed for successful registration and use of the app, compliance with reading instructions before and after surgery, and sending pain scores and/or wound images. The number of surgeries cancelled, postoperative complications, 30-d readmissions, and phone calls for surgery-related questions were examined. RESULTS Fifty-four of the 56 patients successfully registered, downloaded, and used the app and read and complied with instructions both before and after surgery. There were no cancelled surgeries. There was 1 postoperative complication. There were no readmissions. Eight of the 54 patients (14.8%) called the office on a single occasion for a surgery related question. CONCLUSION We demonstrate the utility of a smartphone application in the perioperative neurosurgical care setting with regard to patient compliance and satisfaction as well as surgery cancellations and readmissions. Further study of a larger number of patients with a control group is warranted.
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Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | | | - Amjad N Anaizi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Mani N Nair
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Wash-ington, DC
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Herrod PJJ, Adiamah A, Boyd-Carson H, Daliya P, El-Sharkawy AM, Sarmah PB, Hossain T, Couch J, Sian TS, Wragg A, Andrew DR, Parsons SL, Lobo DN. Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact. BMJ Open 2019; 9:e028753. [PMID: 31519672 PMCID: PMC6747666 DOI: 10.1136/bmjopen-2018-028753] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy. DESIGN This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale. SETTING Five NHS Hospital Trusts in the East Midlands region of England. PARTICIPANTS We identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants. INTERVENTIONS Participants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope. MAIN OUTCOME MEASURES The primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families. RESULTS Of the 339 respondents, 163 (48%) were aged <65 years, with 111 (68%) being in employment. Sixty-six (19%) participants had their operations cancelled on the day. Only 69 (62%) of working adults were able to return to work during the time scheduled for their operation, with a mean loss of 5 working days (SD 10). Additional working days were lost subsequently by 60 (54%) participants (mean 7 days (SD 10)). Family members of 111 (33%) participants required additional time off work (mean 5 days (SD 7)). Over 30% of participants reported extreme levels of sadness, disappointment, anger, frustration and stress. At least moderate concern about continued symptoms was reported by 234 (70%) participants, and 193 (59%) participants reported at least moderate concern about their deteriorating condition. CONCLUSIONS The cancellation of elective surgery during the winter had an adverse impact on patients and the economy, including days of work lost and health-related anxiety. We recommend better planning, and provision of more notice and better support to patients.
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Affiliation(s)
- Philip J J Herrod
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Alfred Adiamah
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK
| | - Hannah Boyd-Carson
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Prita Daliya
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | | | - Tanvir Hossain
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Jennifer Couch
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Tanvir S Sian
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Andrew Wragg
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - David R Andrew
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK
| | - Simon L Parsons
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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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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Análisis retrospectivo de las suspensiones quirúrgicas y de los factores influyentes durante 8 años. Cir Esp 2019; 97:213-221. [DOI: 10.1016/j.ciresp.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 11/17/2022]
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Stewart JJ, Fayed I, Henault S, Kalantar B, Voyadzis JM. Use of a Smartphone Application for Spine Surgery Improves Patient Adherence with Preoperative Instructions and Decreases Last-minute Surgery Cancellations. Cureus 2019; 11:e4192. [PMID: 31106092 PMCID: PMC6504025 DOI: 10.7759/cureus.4192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Smartphone applications (apps) are being increasingly utilized in the health care arena to improve patient care and outcomes. Objective: To further demonstrate the ability of a smartphone app to improve patient compliance with preoperative instructions and to decrease the number of last-minute surgery cancellations. Methods: Patients undergoing spine surgery were prospectively accrued. Smartphone app users were compared to non-app users. Patient adherence with preoperative instructions as well as last-minute surgery cancellations were analyzed. Results: All 85 app users adhered to preoperative instructions according to the acknowledgements sent to the web portal, and there were no cancelled surgeries. Among the 89 non-app users, there were five cancelled surgeries (5.6%). Conclusions: We demonstrate the ability of a smartphone application to improve patient adherence with preoperative instructions and decrease last-minute surgery cancellations.
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Affiliation(s)
- Jeffrey J Stewart
- Miscellaneous, Georgetown University School of Medicine, Washington DC, USA
| | - Islam Fayed
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Shawnda Henault
- Miscellaneous, Georgetown University School of Medicine, Washington DC, USA
| | - Babak Kalantar
- Orthopaedics, Medstar Georgetown University Hospital, Washington DC, USA
| | - Jean-Marc Voyadzis
- Neurosurgery, Medstar Georgetown University Hospital, Washington DC, USA
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Reducing Cancellations and Optimizing Surgical Scheduling of Ophthalmology Cases at a Veterans Affairs Medical Center. J Healthc Qual 2019; 41:83-90. [DOI: 10.1097/jhq.0000000000000187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Naik SV, Dhulkhed VK, Shinde RH. A Prospective Study on Operation Theater Utilization Time and Most Common Causes of Delays and Cancellations of Scheduled Surgeries in a 1000-Bedded Tertiary Care Rural Hospital with a View to Optimize the Utilization of Operation Theater. Anesth Essays Res 2019; 12:797-802. [PMID: 30662110 PMCID: PMC6319069 DOI: 10.4103/aer.aer_132_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The operation theater (OT) complex is a costly component of a hospital budget expenditure. This area of hospital activity requires maximum utilization to ensure optimum cost benefit. To achieve a high level of utilization in the OT, it is necessary to efficiently coordinate number of activities and personnel. Methods: This study was conducted in a 1000-bedded tertiary care teaching hospital in rural maharashtra over aperiod of two months. The OT complex consists of eight major OTs. Normal working hours for routine scheduled cases on all working days except Sundays and public holidays. Results: Total study period consisted of 96 working days. There were a total of eight OT tables of various specialties, and parameters were observed during the routine hours excluding Sundays and holidays. The total procedure time was maximum for ENT followed by orthopedics and least for obstetrics. Room turnover time was maximum for obstetrics followed by general and oncosurgery. Case delays were maximum in general surgery and least for ophthalmology. The most common reason for delay in starting the operation table was patient getting shifted late from the ward and administrative causes. The most prominent reasons for cancellation were lack of operating room time followed by medical reasons of the patient. Conclusion: We concluded that most of the causes of delays and cancellations of surgeries were avoidable with proper preoperative planning and optimization of patients and resources and good communication between surgeon anesthesiologists and the nursing staff.
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Affiliation(s)
- Shraddha Vidyadhar Naik
- Department of Anesthesiology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Vithal Krishna Dhulkhed
- Department of Anesthesiology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Rewa Hemant Shinde
- Department of Anesthesiology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Douglas RG, Psaltis AJ, Rimmer J, Kuruvilla T, Cervin A, Kuang Y. Phase 1 clinical study to assess the safety of a novel drug delivery system providing long‐term topical steroid therapy for chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:378-387. [DOI: 10.1002/alr.22288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | - Alkis J. Psaltis
- Department of Otolaryngology Head and Neck SurgeryThe Queen Elizabeth Hospital Woodville South South Australia
| | - Joanne Rimmer
- Monash Health Melbourne Australia
- Department of SurgeryMonash University Melbourne Australia
| | - Tom Kuruvilla
- Otolaryngology–Head and Neck SurgerySpecialists at Forte 2 Christchurch New Zealand
| | - Anders Cervin
- University of Queensland Centre for Clinical ResearchRoyal Brisbane & Women's Hospital Campus Herston QLD Australia
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Cho HS, Lee YS, Lee SG, Kim JM, Kim TH. Reasons for Surgery Cancellation in a General Hospital: A 10-year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010007. [PMID: 30577514 PMCID: PMC6338898 DOI: 10.3390/ijerph16010007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/04/2022]
Abstract
Background: This study researched related causes that make scheduled surgeries canceled not to be conducted and based on the research it is to derive issues in order to reduce surgery cancellation. Methods: We analyzed the association of surgery cancellation with patient characteristics, surgical characteristics and surgery schedule related characteristics, using electronic medical record (EMR) data on surgeries conducted at a university hospital in Korea over 10 years. Additionally, we examined the reasons for surgery cancellation based on patient and hospital characteristics. We used chi-square tests to analyze the distribution of various characteristics according to reasons for surgery cancellation. Multivariate logistic regression analyses were conducted to evaluate the factors associated with surgery cancellation. Results: Among 60,333 cases, surgery cancellation rate was 8.0%. The results of the logistic regression indicated a high probability of surgery cancellation when the patient was too old (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.14–1.59), when it was a neurosurgery case (OR: 1.39, 95% CI: 1.21–1.59), when regional anesthesia was used (OR: 1.15, 95% CI: 1.07–1.24) or when it was a planned surgery (OR: 2.45, 95% CI: 2.21–2.73). The surgery cancellation rate was lower when the patient was female (OR: 0.87, 95% CI: 0.82–0.93) or when the surgery was related to Obstetrics & Gynecology (OR: 0.53, 95% CI: 0.46–0.60) or Ophthalmology (OR: 0.66, 95% CI: 0.56–0.79). Among the canceled 4834 cases, the surgery cancellation rate for the reasons of patients was 93.2% and the surgery cancellation rate for the reasons of a hospital was 6.8%. Conclusions: This study found that there are related various causes to cancel operations, including patient characteristics, surgery related characteristics and surgery schedule related characteristics and it means that it would be possible for some reasons to be prevented. Every medical institution should consider the operation cancellation as an important issue and systematic monitoring should be needed.
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Affiliation(s)
- Hyun-Sun Cho
- PI (Performance Improvement) Team, Dongguk University Ilsan Hospital, Gyeongi-Do 10326, Korea.
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea.
| | - Ye Seol Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea.
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
| | - Sang Gyu Lee
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea.
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
| | - Ji Man Kim
- Health Insurance Review and Assessment Service, Wonju 26465, Korea.
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea.
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea.
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Prin M, Eaton J, Mtalimanja O, Charles A. High Elective Surgery Cancellation Rate in Malawi Primarily Due to Infrastructural Limitations. World J Surg 2018; 42:1597-1602. [PMID: 29147893 DOI: 10.1007/s00268-017-4356-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The provision of safe and timely surgical care is essential to global health care. Low- and middle-income countries have a disproportionate share of the global surgical disease burden and struggle to provide care with the given resources. Surgery cancellation worldwide occurs for many reasons, which are likely to differ between high-income and low-income settings. We sought to evaluate the proportion of elective surgery that is cancelled and the associated reasons for cancellation at a tertiary hospital in Malawi. METHODS This was a retrospective review of a database maintained by the Department of Anesthesiology at Kamuzu Central Hospital in Lilongwe, Malawi. Data were available from August 2011 to January 2015 and included weekday records for the number of scheduled surgeries, the number of cancelled surgeries, and the reasons for cancellation. Descriptive statistics were performed. RESULTS Of 10,730 scheduled surgeries, 4740 (44.2%) were cancelled. The most common reason for cancellation was infrastructural limitations (84.8%), including equipment shortages (50.9%) and time constraints (33.3%). Provider limitations accounted for 16.5% of cancellations, most often due to shortages of anaesthesia providers. Preoperative medical conditions contributed to 26.3% of cancellations. CONCLUSION This study demonstrates a high case cancellation rate at a tertiary hospital in Malawi, attributable primarily to infrastructural limitations. These data provide evidence that investments in medical infrastructure and prevention of workforce brain drain are critical to surgical services in this region.
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Affiliation(s)
- Meghan Prin
- Department of Anesthesiology and Critical Care, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH-505, New York, NY, 10032, USA.
| | - Jessica Eaton
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Onias Mtalimanja
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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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Luo L, Liu C, Feng L, Zhao S, Gong R. A random forest and simulation approach for scheduling operation rooms: Elective surgery cancelation in a Chinese hospital urology department. Int J Health Plann Manage 2018; 33:941-966. [PMID: 29956373 DOI: 10.1002/hpm.2552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 02/05/2023] Open
Abstract
Many hospitals encounter surgery cancelations for various reasons. We present a methodology applying data mining and simulation to optimize operating room (OR) scheduling in a urology department in West China Hospital. To the best of our knowledge, this is 1 of the first efforts to seek an optimal schedule solution based on cancelation risk of elective surgeries as well as OR allocation between elective and nonelective surgeries. First, chi-square test and random forest prediction modeling were used to predict potential elective surgeries with high cancelation risk, and the factors, including surgeon, number of days since admission of patient, first surgery or not, etc., that influence elective surgery cancelation were identified. Second, a simulation technology was designed to compare 7 different scheduling strategies. The results demonstrated that for elective surgery, cancelation rate low surgery first outperformed the others and increased the productivity of the ORs from 72% to 83%, while for nonelective surgery performed in a separate OR, there was no improvement because the supply was greater than necessary at present. However, in total, the selected strategies led to 7% higher productivity.
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Affiliation(s)
- Li Luo
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Chuang Liu
- Business School, Sichuan University, Chengdu, Sichuan, China.,Logistics Engineering School, Chengdu Vocational & Technical College of Industry, Chengdu, Sichuan, China
| | - Li Feng
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Shuzhen Zhao
- Outpatient Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Renrong Gong
- Operating Room Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
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30
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Da'ar OB, Al-Mutairi T. How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method. BMC Health Serv Res 2018; 18:454. [PMID: 29903002 PMCID: PMC6003070 DOI: 10.1186/s12913-018-3247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background Cancelation of same-day surgery is a common global problem, wasting valuable hospitals’ operating room (OR) times and imposing significant economic costs. There is limited evidence to support the association between frequency of same-day surgery cancelation and patient demographics, time-related variables, healthcare provider reasons for cancelation, and clinical procedures in Saudi Arabia. The aim of this study was to explore this relationship, providing an understanding of the local context. Methods A retrospective cross-sectional study that retrieved medical records to examine the association between the frequency of same-day surgery cancelation and covariates including patient demographics, time-related variables, healthcare provider reason for cancelation, and clinical procedures. The data covered from January 2014 to December 2014 at King Fahad National Guard Hospital in Riyadh. We considered 440 patients that met the inclusion criteria for final analysis. The cancelation was regarded less frequent if a patient canceled once in the12 months and more frequent if a patient canceled two times or more in the same period. We used descriptive statistics to summarize data and employed a probit regression to estimate the association of frequency of same-day surgery cancelation and covariates via maximum likelihood method. King Abdullah International Medical Research Center granted the institutional approval. Results Our study suggests that while reasons of unavailability of OR time were associated with less frequent same-day surgery cancelation, scheduling issues were linked to more frequent cancelations, compared with reasons for patients being unwell on the day of surgery. Waiting time of more than six hours and morning sessions were associated with less frequent cancelations compared to shorter waiting time and afternoon sessions. Compared to general procedures, specialized clinical procedures were associated with cancelations that are more frequent. Further, female patients were more likely to have more cancelations. Finally, being married was associated with the less frequent cancelation of same-day surgery. Conclusion Our findings provide evidence of determinants of the frequency of same-day surgery cancelations. This study draws several important implications for hospitals, especially on optimal utilization of resources and minimization of same-day surgery cancellations. The study also offers several recommendations that we believe will spur future research.
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Affiliation(s)
- Omar B Da'ar
- Department of Health Systems & Quality Management, College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. .,Graduate School of Professional Studies, St. Mary's University of Minnesota, Minneapolis, MN, USA.
| | - Talal Al-Mutairi
- King Fahad Hospital, King Abdulaziz Medical City, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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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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Cookson G, Jones S, Laliotis I. Cancelled Procedures in the English NHS: Evidence from the 2010 Tariff Reform. HEALTH ECONOMICS 2017; 26:e126-e139. [PMID: 28205279 DOI: 10.1002/hec.3486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/07/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
This paper explores the role of incentives in the English National Health Service. Until financial year 2009/2010, elective procedures that were cancelled after admission received a fixed reimbursement associated with a specific healthcare resource group code. We investigate whether this induced trusts to admit and then cancel, rather than cancel before admission and/or to cancel low fee over high fee work. As the tariff was ended in April 2010, we conduct an interrupted time series analysis to examine if their behaviour was affected after the tariff removal. The results indicate a small, yet statistically significant, decline in the probability of a last minute cancellation in the post-tariff period, especially for certain types of patients and diagnoses. Copyright © 2017 John Wiley & Sons, Ltd.
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Yu K, Xie X, Luo L, Gong R. Contributing factors of elective surgical case cancellation: a retrospective cross-sectional study at a single-site hospital. BMC Surg 2017; 17:100. [PMID: 28893218 PMCID: PMC5594612 DOI: 10.1186/s12893-017-0296-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/05/2017] [Indexed: 02/05/2023] Open
Abstract
Background Case cancellation (CC) has significant impact on the efficiency of operating room (OR) management, which can be mitigated by taking preventive measures. In this study, using the data of the West China Hospital (WCH), we identified the effect of contributing factors and recommended hospital interventions to facilitate CC prevention. Method We conducted a retrospective review of 11,331 elective surgical cases from January 1 to December 31, 2014. CC reasons were grouped into six categories. The methods of descriptive statistics and hypothesis test were used to identify the effect of factors. Results CC reasons (746) were divided into six broad categories: workup related (preoperative diagnostic assessment issues or sudden medical condition changes) (25.8%), non-specified reasons (25.8%), coordination issues (15.1%), patient related (13.0%), support system issues (11.8%), and doctor related (8.5%). The types of the most frequently performed operations are identified, as well as their CRs. The cancellation rate (CR) of males was lower than that of females (16.7% to 18.3%). A large difference in the CRs existed among doctors. The CR on Monday was significantly higher than the other four weekdays. Conclusions Workup related issues, the types of procedures, the menstrual cycle of females, highly imbalanced CRs among doctors, and tendency of cancellation on Monday are the major identified factors, which account for a significant amount of preventable cancellations. It is suggested that corresponding hospital interventions can reduce CR and improve OR efficiency, including maintaining effective coordination, good communication and well-designed preoperative assessment processes, focusing on the type of procedures which are more time-consuming and complex, paying special attention to the physiology of females during surgery planning, taking measures to reduce CR of top eight doctors, and improving surgery scheduling on Monday.
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Affiliation(s)
- Kaiye Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Xiaolei Xie
- Department of Industrial Engineering, Tsinghua University, Beijing, China.
| | - Li Luo
- Department of Industrial Engineering and Engineering Management, Service Management Institute, Business School of Sichuan University, Chengdu, China
| | - Renrong Gong
- Operating Room Department, West China Hospital, Sichuan University, Chengdu, China
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Abeeleh MA, Tareef TM, Hani AB, Albsoul N, Samarah OQ, ElMohtaseb MS, Alshehabat M, Ismail ZB, Alnoubani O, Obeidat SS, Halawa SA. Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement. Ann Surg Treat Res 2017; 93:65-69. [PMID: 28835881 PMCID: PMC5566748 DOI: 10.4174/astr.2017.93.2.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Methods Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. Results During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). Conclusion This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.
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Affiliation(s)
- Mahmoud Abu Abeeleh
- Department of Cardiothoracic Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Tareq M Tareef
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Amjad Bani Hani
- Department of Cardiothoracic Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Nader Albsoul
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - M S ElMohtaseb
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Musa Alshehabat
- Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zuhair Bani Ismail
- Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar Alnoubani
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Salameh S Obeidat
- Department of Anesthesia and Critical Care, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Sami Abu Halawa
- Department of Anesthesia and Critical Care, Faculty of Medicine, The University of Jordan, Amman, Jordan
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Sander IM, Liepert TT, Doney EL, Leevy WM, Liepert DR. Patient Education for Endoscopic Sinus Surgery: Preliminary Experience Using 3D-Printed Clinical Imaging Data. J Funct Biomater 2017; 8:E13. [PMID: 28387702 PMCID: PMC5491994 DOI: 10.3390/jfb8020013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 01/17/2023] Open
Abstract
Within the Ear, Nose, and Throat (ENT) medical space, a relatively small fraction of patients follow through with elective surgeries to fix ailments such as a deviated septum or occluded sinus passage. Patient understanding of their diagnosis and treatment plan is integral to compliance, which ultimately yields improved medical outcomes and better quality of life. Here we report the usage of advanced, polyjet 3D printing methods to develop a multimaterial replica of human nasal sinus anatomy, derived from clinical X-ray computed tomography (CT) data, to be used as an educational aid during physician consultation. The final patient education model was developed over several iterations to optimize material properties, anatomical accuracy and overall display. A two-arm, single-center, randomized, prospective study was then performed in which 50 ENT surgical candidates (and an associated control group, n = 50) were given an explanation of their anatomy, disease state, and treatment options using the education model as an aid. Statistically significant improvements in patient ratings of their physician's explanation of their treatment options (p = 0.020), self-rated anatomical understanding (p = 0.043), self-rated understanding of disease state (p = 0.016), and effectiveness of the visualization (p = 0.007) were noted from the population that viewed the 3D education model, indicating it is an effective tool which ENT surgeons may use to educate and interact with patients.
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Affiliation(s)
- Ian M Sander
- Department of Biological Sciences, University of Notre Dame, South Bend, IN 46556, USA.
| | - Taimi T Liepert
- Michiana Sleep Solutions and Allied ENT Speciality Center, South Bend, IN 46635, USA.
| | - Evan L Doney
- Department of Biological Sciences, University of Notre Dame, South Bend, IN 46556, USA.
| | - W Matthew Leevy
- Department of Biological Sciences, University of Notre Dame, South Bend, IN 46556, USA.
| | - Douglas R Liepert
- Department of Biological Sciences, University of Notre Dame, South Bend, IN 46556, USA.
- Michiana Sleep Solutions and Allied ENT Speciality Center, South Bend, IN 46635, USA.
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Sharouf F, Baig Mirza A, Moosajee V, Plummer S, Bhatti IM, Zaben M. Analysis of neuro-theatre utilisation and reasons for cancellation to improve efficiency and productivity. J Perioper Pract 2017; 27:82-86. [PMID: 29328748 DOI: 10.1177/175045891702700404] [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: 06/14/2016] [Accepted: 08/26/2016] [Indexed: 06/07/2023]
Abstract
In neurosurgery, much emphasis has recently been placed on theatre cancellation and time utilization as a key hospital management performance indicator. We sought to evaluate our unit's theatre throughput efficiency and identify the causes of elective surgery cancellations. We retrospectively audited all scheduled elective neurosurgical procedures over a period of nine months. Mean theatre utilization time was 47.0%. The common causes of cancellations were lack of theatre time (32%), non-availability of beds in recovery room (18.6%), and insufficient preoperative patient preparation (5.5%). Inefficiencies were noted in turnover of patients and inaccurate prediction of operative time. Our theatre utilization time is consistent with available literature; however, cancellations of elective surgery waste valuable operative time and resources. The study concludes that a multi-dimensional approach must be taken to improve theatre utilization and reduce cancellation rates. A pre-assessment clinic has been introduced in order to reduce cancellation rates.
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Affiliation(s)
- Feras Sharouf
- University Hospital of Wales, Department of Neurosurgery, UK
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Appavu ST, Al-Shekaili SM, Al-Sharif AM, Elawdy MM. The Burden of Surgical Cancellations and No-Shows: Quality management study from a large regional hospital in Oman. Sultan Qaboos Univ Med J 2016; 16:e298-302. [PMID: 27606108 DOI: 10.18295/squmj.2016.16.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/20/2016] [Accepted: 04/07/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The operating theatre (OT) is a vital facility that utilises a considerable portion of the hospital's budget; thus proper OT utilisation is essential. Surgical cancellation is a leading cause of OT underutilisation. This study aimed to report the rate and reasons for surgical cancellations and no-shows in a large regional hospital in Oman. METHODS This study took place as part of a retrospective quality management project at the Ibri Regional Hospital, Ibri, Oman. All elective surgical procedures scheduled between January and December 2014 were included. Cancelled procedures were reviewed to determine the reasons for cancellation. RESULTS A total of 4,814 elective procedures were scheduled during the study period; of these, 1,235 (26%) were cancelled. Patient no-shows were the most prevalent reason for surgical cancellation (63%), followed by surgical reasons (17%); in contrast, OT-associated reasons were responsible for only 2% of cancellations. According to speciality, general surgery had the highest percentage of total cancellations (65%), while ear, nose and throat had the highest rate of surgical cancellations among their scheduled cases (42%). CONCLUSION Ibri Regional Hospital had a higher surgical cancellation rate due to no-shows than those reported in the literature. Regular audits, quality management projects and the appointment of a dedicated procedure booking coordinator may enhance proper utilisation of the OT, potentially saving funds, conserving resources and alleviating the burden of cancellations.
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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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Gaucher S, Boutron I, Marchand-Maillet F, Baron G, Douard R, Béthoux JP. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial. PLoS One 2016; 11:e0147194. [PMID: 26829478 PMCID: PMC4734771 DOI: 10.1371/journal.pone.0147194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159
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Affiliation(s)
- Sonia Gaucher
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
- * E-mail:
| | - Isabelle Boutron
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Florence Marchand-Maillet
- Unité de Chirurgie Ambulatoire, Pôle Digestif-Anesthésie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Est, Hôpital Saint-Antoine, Paris, France
| | - Gabriel Baron
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Richard Douard
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Pierre Béthoux
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
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Leslie RJ, Beiko D, van Vlymen J, Siemens DR. Day of surgery cancellation rates in urology: Identification of modifiable factors. Can Urol Assoc J 2015; 7:167-73. [PMID: 23069699 DOI: 10.5489/cuaj.12020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice. METHODS We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients. RESULTS Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, process-related causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected. CONCLUSIONS This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.
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Affiliation(s)
| | - Darren Beiko
- Departments of Urology, Queen's University, Kingston, ON
| | - Janet van Vlymen
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - D Robert Siemens
- Departments of Urology, Queen's University, Kingston, ON; ; Oncology, Queen's University, Kingston, ON; ; Biomedical and Molecular Sciences, Queen's University, Kingston, ON
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Talati S, Gupta AK, Kumar A, Malhotra SK, Jain A. An analysis of time utilization and cancellations of scheduled cases in the main operation theater complex of a tertiary care teaching institute of North India. J Postgrad Med 2015; 61:3-8. [PMID: 25511210 PMCID: PMC4944363 DOI: 10.4103/0022-3859.147009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Context: Operation theater (OT) utilization. Aims: To analyze the time utilization and to assess the stated causes of cancellations of scheduled cases in the OT complex of a tertiary care teaching institute. Settings and Design: This prospective study was carried out from December 2010 to April 2011. Materials and Methods: each of the 16 OT tables was observed for 6 days (total 96 days). The available resource hours were taken as 0800-1600 hrs. (480 min/day; 46,080 min in 96 days). The following parameters were recorded — time spent on supportive services, time spent on actual surgery, room turn over time, time spent for total procedure and time between entry and exit of patient. Statistical Analysis: Data were analyzed using the SPSS software version 15. Results: Of the total 325 scheduled cases, 252 were operated and 73 (22.5%) were cancelled. There were delays on 15 days (15.63%) in starting the OT table at the scheduled time. Of the total resource hours (46,080 min), the mean “Raw utilization” was 37,573 min (81.54%) and the “Adjusted utilization” was 39,668 min (86.09%). The mean time spent on “supportive services” was 5539 min (12.02%) and on “actual surgery”’ was 28,277 min (61.37%), and the “room turn over time” was 2095 min (5.39%). Among the stated reasons for cancellations, lack of operating time — 57 cases (78.1%) — was the most common. Conclusion: Study of time utilization and cancellation are important tools in assessing the optimal utilization of available resource hours in an OT.
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Affiliation(s)
- S Talati
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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O’Dwyer AJ, Pridgeon S, Green JSA. Preventing ‘same-day’ cancellations in elective urological surgery: Are different strategies needed for inpatient, day case and procedural admissions? JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815587213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Late surgical cancellations adversely impact patients and efficient use of hospital resources. Non-clinical reasons have a cancellation rate of 0.77%, but when including clinical reasons this rate rises to 13%–15%.1–4 Objectives: The objectives of this article are to identify reasons for cancellations of elective urological procedures at a single centre across different procedure types and to make recommendations for prevention. Methods: Rates and reasons for late cancellation of urological surgery were retrospectively audited for the period April 2009 to April 2012. For each cancellation, reasons were classified: Patient-related, Facility-related, Work-up, Change in medical condition, Process-related, Miscellaneous. Results: During the study period, 9039 elective operations were reviewed to find 2804 cancellations: 580, 450, 1774 (rates = 15.6%, 21.7% and 29.3%) for inpatient, day case and procedure-room cases, respectively. Thirty per cent of inpatient cancellations were due to process-related factors, and 35% due to change in medical condition, of which 78% were urinary tract infection (UTI). Patient-related factors accounted for the majority (52%) of day case and procedural cancellations. Conclusions: Causes for cancellations vary according to procedure type, suggesting tailored strategies are needed for prevention. Change in medical condition caused similar rates of cancellation across procedure type (35%, 28% and 25%). Inpatient procedures were prone to process-related cancellations especially over-run theatre sessions. Patient surveys and reminders closer to time of operation, improvements in preoperative UTI detection and treatment and further process mapping is recommended to identify exact reasons behind and decrease cancellations.
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Affiliation(s)
- AJ O’Dwyer
- Urology Department, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - S Pridgeon
- Urology Department, Whipps Cross University Hospital, Barts Health NHS Trust, UK
| | - JSA Green
- Urology Department, Whipps Cross University Hospital, Barts Health NHS Trust, UK
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Bass E, Gill P. Report into "on the day cancellations" for plastic surgery in patients who failed to stop their medication. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:bmjquality_uu204762.w2037. [PMID: 26734293 PMCID: PMC4645892 DOI: 10.1136/bmjquality.u204762.w2037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/09/2014] [Indexed: 11/25/2022]
Abstract
It was noted that a number of patients were having their procedures cancelled on the day of surgery because their antiplatelet or anticoagulative medications had not been stopped preoperatively. The team recognised that this problem was leading to an unnecessary waste of the department‘s labour and financial resources, and more importantly was becoming a source of disappointment and anxiety to patients. A retrospective analysis of all plastic surgery cases was performed for procedures listed for the previous 12 months. All cancellations and the reasons for them were recorded, which came to 23 cases. The sum of the financial tariffs for each cancelled procedure was calculated to assess the financial impact of the identified problem: £20,000. A root cause analysis was performed to assess where this problem was arising in the patient's preoperative journey. The common theme was the lack of information for the gatekeeper regarding the patients’ anticoagulant and antiplatelet medications. A new gatekeeper form was introduced to practice with a subsection specifically highlighting antiplatelet and anticoagulative medications. In addition, this issue was highlighted to the relevant staff in the department. After four months, a second PDSA cycle was performed in the same manner. Seven cases were cancelled due to anticoagulants or antiplatelets not being stopped prior to surgery. This equated to a net loss of £11,865 to the department when projected over 12 months, improving on the performance prior to the newly introduced changes.
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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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Hovlid E, Bukve O. A qualitative study of contextual factors' impact on measures to reduce surgery cancellations. BMC Health Serv Res 2014; 14:215. [PMID: 24884879 PMCID: PMC4023492 DOI: 10.1186/1472-6963-14-215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes. In this study, we explore how contextual factors affected measures to reduce surgery cancellations, which are a persistent problem in healthcare. We discuss the usefulness of the theoretical framework provided by the model for understanding success in quality (MUSIQ) for this kind of research. METHOD We performed a qualitative case study at Førde Hospital, Norway, where we had previously demonstrated a reduction in surgery cancellations. We interviewed 20 clinicians and performed content analysis to explore how contextual factors affected measures to reduce cancellations of planned surgeries. RESULTS We identified three common themes concerning how contextual factors influenced the change process: 1) identifying a need to change, 2) facilitating system-wide improvement, and 3) leader involvement and support. Input from patients helped identify a need to change and contributed to the consensus that change was necessary. Reducing cancellations required improving the clinical system. This improvement process was based on a strategy that emphasized the involvement of frontline clinicians in detecting and improving system problems. Clinicians shared information about their work by participating in improvement teams to develop a more complete understanding of the clinical system and its interdependencies. This new understanding allowed clinicians to detect system problems and design adequate interventions. Middle managers' participation in the improvement teams and in regular work processes was important for successfully implementing and adapting interventions. CONCLUSION Contextual factors interacted with one another and with the interventions to facilitate changes in the clinical system, reducing surgery cancellations. The MUSIQ framework is useful for exploring how contextual factors influence the improvement process and how they influence one another. Discussing data in relation to a theoretical framework can promote greater uniformity in reporting findings, facilitating knowledge-building across studies.
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Affiliation(s)
- Einar Hovlid
- Sogn og Fjordane University College, Institute of Social Science, Postbox 133, Sogndal 6851, Norway.
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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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Kamalo PD. Letter to the Editor: Predominantly patient-initiated cancellation of operation--could it be a fallacy? Int J Surg 2014; 12:366. [PMID: 24508306 DOI: 10.1016/j.ijsu.2014.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
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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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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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Cookson G, Jones S, McIntosh B. Cancelled procedures: inequality, inequity and the National Health Service reforms. HEALTH ECONOMICS 2013; 22:870-876. [PMID: 22760925 DOI: 10.1002/hec.2860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 05/31/2012] [Accepted: 06/08/2012] [Indexed: 06/01/2023]
Abstract
Using data for every elective procedure in 2007 in the English National Health Service, we found evidence of socioeconomic inequality in the probability of having a procedure cancelled after admission while controlling for a range of patient and provider characteristics. Whether this disparity is inequitable is inconclusive.
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