IMPACT OF AUDIT AND POLICY IMPLEMENTATION ON ELECTIVE CASE CANCELLATION RATE: A RETROSPECTIVE STUDY

Abstract

Objectives: Cancellation of elective posted case on the day of surgery is the most distressing news for the patient and their wards and also leads to wastage of hospital resources. Cancellation of elective surgical case is a preventable situation, if the involved team members take necessary steps suitable for successful conduct of surgery. This study was done to assess whether audit of case cancellation and policies implemented have reduced the rate of case cancellation. Methods: This audit was conducted for the past 3 years (2016–2018) in tertiary care hospital with 1500 beds and 12 functional elective operating rooms distributed among eleven specialties. Case cancellation done after the case was posted in the list was considered for the audit. With the consensus of both the surgeon and anesthesiologist, cancelled cases were entered in the cancellation form with the reasons specified. The forms were collected at the end of the day. Cancellations were discussed in operation theater (OT) committee meeting and new policies were made and remedial measures were taken. Results: Total numbers of elective posted cases were 6094, 5623, and 5353 and case cancellation rate was 8%, 5.6%, and 5.7% in 2016, 2017, 2018, respectively. Patient-related factors were 4.45%, 2.86%, and 3.51%, surgery-related were 2.3%, 1.5%, and 1.21%, anesthesia-related were 0.07%, 0.21%, and 0.3% and infrastructure-related cancellation rate was 1.3%, 1.07%, and 0.69%, respectively. The cancellation rates have been decreased with statistical significance of p<0.00001. Conclusion: Regular audit of OT utilization and policy implementation will significantly reduce the avoidable causes of case cancellation.