The Burden of Surgical Cancellations: A Quality Improvement Study on the Importance of Preoperative Assessment.

Saphalya Pattnaik,Vandana Bishnoi,Sheetal K Dixit

doi:10.7759/cureus.21731

Abstract

BackgroundThe operating room (OR) is a critical facility that consumes a significant percentage of the hospital's resources, so it must be used judiciously. Surgical cancellation is a chief cause of OR underutilization. The purpose of this study was to hold medical concerns accountable for surgical cancellations at a large tertiary care hospital in Maharashtra, India.MethodsThe Plan, Do, Study, and Act (PDSA) cycle is a tool for analyzing change and learning via action. We used this method to determine the origins of errors, identify key points, and test change interventions such as an individually tailored anesthetic plan, provision of a pre-anesthesia evaluation clinic in the outpatient department, reevaluating patients, and rechecking the preoperative checklist. This study was undertaken as a part of a quality improvement project at our hospital in India. All elective surgical operations scheduled between January and November 2020 were included, and canceled procedures were investigated to identify potential reasons.ResultsDuring the auditing period, 7,709 elective operations were scheduled; 68 (0.88%) of them were canceled. After piloting interventions, the rate of cancellations dropped from 1.08% to 0.67% in the succeeding cycle. A root cause analysis of the data revealed that there was a 7.1% decrease in cancellations due to hypertension, a 3.8% decrease due to insufficient routine blood tests, and a 1.9% decrease in the inappropriate preoperative workup, while we saw an increase in fever (5.5%) and blood sugar level (1.9%) discrepancies.ConclusionsDr. D. Y. Patil Hospital & Research Centre in Pune, India, had cancellations in scheduled ORs due to associated medical co-morbidity that were potentially reducible post-intervention and could be replicated for application in various tertiary care hospitals. Regular monthly audits, quality improvement projects, and the designation of an organized system may enhance the proper utilization of the OR which could potentially save funds, preserve resources, alleviate the burden of patients, and reduce cancellations to a minimum.

Highlights

The operating room (OR) is the pivot of any tertiary hospital, requiring a considerable workforce and expenditure from the hospital budget
We used this method to determine the origins of errors, identify key points, and test change interventions such as an individually tailored anesthetic plan, provision of a pre-anesthesia evaluation clinic in the outpatient department, reevaluating patients, and rechecking the preoperative checklist
A root cause analysis of the data revealed that there was a 7.1% decrease in cancellations due to hypertension, a 3.8% decrease due to insufficient routine blood tests, and a 1.9% decrease in the inappropriate preoperative workup, while we saw an increase in fever (5.5%) and blood sugar level (1.9%) discrepancies

Summary

Introduction

The operating room (OR) is the pivot of any tertiary hospital, requiring a considerable workforce and expenditure from the hospital budget. Canceling elective surgery on the scheduled date causes psychological anguish to the operating surgeons, OR technicians, ward nurses, and perioperative anesthetists and prolongs and worsens patient suffering. These cancellations may result in disgruntled patients and may be costly, but they are potentially avoidable if proper administrative actions are taken [1,2]. Delayed cancellation of scheduled operations is a major cause of inefficient use of OR time and a misuse of resources It is potentially stressful, with demoralizing effects, and costly to the patient in terms of disruption of daily life and working days lost [3,4]. The purpose of this study was to hold medical concerns accountable for surgical cancellations at a large tertiary care hospital in Maharashtra, India

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