Cancellation Rate Research Articles

Analysis of the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery

Objective: To investigate the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery, and to provide a basis for further improvement of the medical quality of ophthalmic ambulatory surgery. Methods: The data of the appointment for ophthalmic ambulatory surgeries from December 1, 2020 to November 30, 2021, including the patient's general condition, disease diagnosis, proposed surgical arrangement, anesthesia method and the completion of the surgeries, were collected through the electronic medical record management system in Beijing Tongren Hospital, Capital Medical University. The total number and incidence of cancelled surgeries registered in the surgical center were analyzed, the incidence of cancelled surgeries of different ages, sexes, subspecialty surgical types, anesthesia methods, patient sources were analyzed, and the reasons for surgical cancellation were further analyzed. Results: A total of 10, 595 non-cataract ophthalmic day surgeries were applied, of which 827 were temporarily cancelled on the day of surgery, with a cancellation rate of 7.8%. The difference in the same-day surgery cancellation rate at different ages was statistically significant (P<0.001), of which the surgery cancellation rate in toddler and infants was the lowest, which was 2.1% (23/1 110) and 3.4% (2/59), respectively, while the surgery cancellation rate was the highest in elderly patients over 75 years old, at 10.4% (48/462). There was a statistically significant difference in surgical cancellation rates among different sub-specialties (P<0.001), with the lowest surgical cancellation rate in the tumor sub-specialty at 4.5% (33/732), while the corneal sub-specialty had the highest surgical cancellation rate at 14.3% (40/280), followed by the plastic sub-specialty with 11.8% (153/1 297). There were no statistically significant differences in the rate of surgical cancellation between different sexes, anesthesia methods or patients' home address (all P>0.05). The most common reason for same-day surgery cancellation was the absence of the patient on the day of surgery (49.7%, 479/827), followed by changes in the patient's general condition (18.4%, 152/827), and inadequate preoperative preparation (6.0%, 50/827). 64.3% (532/827) of the same-day surgical cancellations were considered to have been avoided by enhancing preoperative communication, consultation and management. Conclusions: The same-day cancellation rate of ambulatory surgery in non-cataract ophthalmology is 7.8%, of which the cancellation rate in elderly patients and in less invasive surgery are higher. The absence of the patient on the same day and the change of the patient's condition are the main reasons for the cancellation of surgery on the same day, and most of them are avoidable.

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

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&lt;0.00001. Conclusion: Regular audit of OT utilization and policy implementation will significantly reduce the avoidable causes of case cancellation.

On the use of partitioning for scheduling of surgeries in the inpatient surgical department.

In hospitals, the efficient planning of the operating rooms (ORs) is difficult due to the uncertainty inherent to surgical services. This is especially true for the inpatient surgical department where complex and long surgeries are often performed along with surgeries on emergency patients. This paper aims to improve the scheduling of the inpatient department by partitioning the elective surgeries into the more predictable surgeries (MPS) group and the less predictable surgeries (LPS) group, based on surgery duration variability, and by scheduling each of the two surgery groups in different ORs. Through a simulation study that comprehensively investigates the impact of the partitioning on different performance measures under various environmental settings, we report important findings and insights. First, partitioning can effectively shorten the waiting times of elective patients for both MPS and LPS groups, but the option should be allowed to reassign patients from the MPS or LPS ORs to the other ORs when needed. Meanwhile, partitioning sometimes slightly increases the elective cancellation rate. Second, the ability to use the available capacity of the ORs as much as possible is key to reducing elective waiting times. Third, partitioning might slightly worsen the waiting times of emergency patients, while the slightly negative impact on emergency patients decreases when the number of ORs is higher. Fourth, the beneficial impact of partitioning on elective patients increases with an increased patient demand. Last, for the settings considered in this study there was no benefit in partitioning the elective patients into more than two groups.

Short notice cancellations - an insight into Irish surgical waiting lists.

BackgroundThe reasons underlying prolonged waiting lists for surgery in Ireland are multifactorial. Patient-related factors including non-attendances contribute in part to the current waiting times.AimsTo determine the rate of short notice cancellation for day case surgery in a model 2 HSE hospital over a 1-month period and to implement an intervention to try and reduce the rate of cancellation.MethodsThe cancellation rate was documented over a 1-month period in the hospital. An intervention was then implemented, involving a phone call to the patient from a member of the surgical team to attempt to reduce the cancellation rate. Cancellations were re-audited after the implementation of the phone intervention.ResultsThe initial audit revealed a cancellation rate of 39.7% during the first month prior to implementation of the phone intervention. A phone call intervention from a member of the surgical team was associated with a decrease in cancellations from 39.7 to 14.6% (p < 0.01).ConclusionsWhile cancellations remained high even after our intervention, a simple phone call was effective and more than halved our cancellation rate. Future efforts need to focus on increasing awareness of patient responsibility for attending scheduled appointments and procedures.

Service Evaluation: Patient Engagement With Online Group Psychotherapy During the COVID-19 Pandemic in West of Scotland

AimsOnline group therapy has gained popularity during the COVID-19 pandemic as an alternative to face-to-face group therapy. This service evaluation is aimed at assessing how this paradigm shift is received by the patients and how the quality of the provided services is assured and potentially improved.Methods1. We have retrospectively compared the attendance records from all psychotherapy groups in North Lanarkshire psychotherapy department between two distinct time periods: from November 2018 to January 2019 when only face-to-face groups were available (5 groups, 29 patients) and from November 2021 to January 2022 when only online groups were available (4 groups, 21 patients).2. In order to prospectively assess patient's views regarding online group therapy, Client Satisfaction Questionnaires (CSQ-4, quantitative and qualitative) were distributed to January 2022 groups only.Results1. The attendance rate was 5% lower in the face-to-face groups (76% vs 81%) while the non-attendance rate was lower by 1% in the online groups (9% vs 8%). The cancellation rate was also smaller by 5% in the online groups (14% to 9%).2. In regard to the service satisfaction rates in the online groups, 57% of patients who responded, answered that “most of their needs have been met by the online services’’, 71% answered “services helped with their problems somewhat’’, 71% answered “they think they would come back to the program again and 66% answered” they are mostly satisfied with the services received.“The predominant positive aspects of the services according to free text comments were” “communication, understanding, sense of community’’ and the negative aspects that need improvement: “return to face-to-face (71% of answers), need personal interaction’’.** We have extended the deadline for the acceptance of the responses to 20th of February 2022 due to mailing systems being slowed down by the pandemic. (7 out of 21 questionnaires have been returned)ConclusionOverall the attendance rates between the online and face-to-face group therapy exhibit minor differences. Concerning the patient satisfaction rates they reveal that the majority of patients who receive group therapy online are above-average satisfied with the services, feel that the online therapy provides a sense community but would prefer to return to face-to-face therapy.Further data and studies will be needed to reach more robust conclusions.

Improving the process of obtaining screening and diagnostic breast MRI: A quality improvement project at an urban VA hospital.

e18641 Background: There are two million female veterans across the United States, a number increasing by more than 18,000 per year. 1 in 8 women will be diagnosed with breast cancer in their lifetime, and studies have shown that servicewomen are 40% more likely to get breast cancer than civilians. The American Cancer Society (ACS) recommends screening MRI in women with 20-25% or greater lifetime risk of breast cancer, and both primary care physicians and oncologists are now ordering these more frequently. The Michael E. DeBakey Veteran’s Affairs Medical Center (MEDVAMC) performs screening mammograms and ultrasounds, but breast MRI is not currently available at the facility. Care in the Community arranges for veterans to obtain these studies at outside facilities. This is a complex process, requiring coordination among multiple departments, the outside MRI facility, and the patient. There are a significant number of MRI order cancellations per month, which can lead to delays in diagnosis or treatment. Methods: We created a comprehensive process map for the current breast MRI ordering process to determine areas for improvement. We looked at all breast MRI orders starting in 12/2020 at the MEDVAMC and determined the rate of cancellation and the rate of benign (BIRADS 1-2) vs non benign (BIRADS 0, 3-5) screening outcomes. We created a Pareto analysis to determine the most common cancellation reasons and p-charts of the percent of cancelled MRI orders per month and a run chart of the percent due to incorrect verbiage. Results: Of the 243 orders placed for MRI for 124 patients from 12/2020 to 1/2022, 64.2% were cancelled. Of the 57% of patients (71/124) with complete MRIs, 35.2% had non-benign findings requiring follow up, excluding known malignancies. Our Pareto analysis showed that most cancellations were due to incorrect verbiage in the order. An intervention in 6/2021 changed the MRI order from a free text box to clickable options, followed by an educational intervention in 12/2021. Cancellations due to incorrect verbiage decreased overall after June, however it has not yet reached significance. It is too early to determine if the educational intervention caused a significant change, however the cancellation rate has decreased. Conclusions: Providing discrete, clickable options within the MRI order has reduced the number of cancellations due to incorrect verbiage, though we have not yet reached significance. Early data suggests that the educational intervention has improved the cancellation rate. Fewer cancellations will lead to more timely studies, which will in turn lead to faster follow up of non-benign findings. Further directions include using a nurse navigator to reduce confusion and delays, further simplifying the ordering process, checking patient phone numbers in clinic, and sending patients home with information on the importance of screening MRI to reduce veteran cancellation.

Impact of personalized care discussions on advance care planning.

e18619 Background: Advanced Care Planning (ACP) involves learning about decisions that may need to be made during care so they are known to family and providers. ACP has been associated with less aggressive medical care near death and improved quality of life.However, despite evidence for their benefit, ACP is inconsistent among patients with advanced cancer. At our institution, only 52% of patients with cancer undergoing palliative intent treatment had an ACP at the time of death. We sought to increase ACP through a quality improvement project intended to proactively identify and introduce patients to Personalized Care Discussions (PCDs). PCDs engage oncology patients and palliative care providers in ACP to articulate goals of care. Methods: A team of palliative care providers, medical oncologists, and administrative staff designed each phase of the intervention. Inclusion criteria to proactively identify patients eligible for a PCD were created along with a workflow to introduce PCDs and schedule a PCD appointment. A plan-do-study-act (PDSA) model was used to test impact of change to the PCD referral workflow and patient inclusion criteria. Each PDSA cycle lasted between 4 and 9 weeks between 6/1/2021 and 1/31/2022. PDSA 1: Oncologist referral to PCD for new patients. PDSA 2: Oncologist referral to PCD for Stage IV patients. PDSA 3: Automatic referral to PCD of Stage IV patients. PDSA 4: Pancreatic patients, any stage, added to PDSA 3 criteria. Results: During the measurement period, 68 patients completed a PCD. While changes to the inclusion criteria throughout PDSA cycles resulted in more total unique patients completing PCDs, the completion rate of eligible patients did not vary significantly across cycles. However, the proportion of patients completing PCDs for oncologists engaged in the project increased during the eight-month QI period (92%) from the previous eight-month period (86%). Conclusions: This project sought to identify and introduce patients to PCDs to improve ACP. We found that access to PCDs was not sufficient to increase completion of PCDs, since fewer than half completed the appointment. However, 68 patients who otherwise may not have completed a PCD did so because of this intervention. Misperceptions of palliative care may contribute to high cancellation rates of PCD appointments. This pattern is seen in the overall low completion rate of palliative care appointments (56% in same timeframe). Informal patient feedback often indicated a preference for care discussions to be with the primary oncologist, whereas our intervention introduced a new provider. These results demonstrate that a trigger to identify patients for PCDs without primary oncologist engagement falls short. Continued focus is needed to determine a proactive approach to identify patients who will benefit most from PCDs to complete ACP proactively.[Table: see text]

Dynamic resource allocation schemes for eMBB and URLLC services in 5G wireless networks

The fifth generation (5G) of wireless networks features three core use cases, namely ultra-reliable and low latency communications (URLLC), massive machine type communications (mMTC), and enhanced mobile broadband (eMBB). These use cases co-exist in many practical scenarios and compete for the same set of time and frequency resources, resulting in a natural trade-off in their performance. In this paper, a network supporting both URLLC and eMBB modes of operation is studied. To guarantee the ultra low latency requirement of URLLC, a dynamic resource allocation scheme indicated by a two-dimensional bitmap is proposed. This approach is capable to achieve finer granularity as well as lower false cancellation rate compared to the state-of-the-art methods. A novel power control and indication method is also proposed to dynamically provide different power control parameters to the user equipment (UE), while guaranteeing the reliability requirement of URLLC and minimizing the impact to eMBB. In addition, we devise a dynamic selection mechanism (DSM) to accommodate diverse scenarios, which is empowered with load prediction to become more intelligent. Our extensive system-level simulation results for eMBB-URLLC co-existence scenarios showcase that the perceived throughput of eMBB UEs is increased by 45.3%, while about 13.3% more UEs are enjoying URLLC services with at most 84% transmit power savings compared to the state-of-the-art methods.

172 Quality improvement project on the peri-procedural management of lumbar punctures

IntroductionCancellation rate of elective lumbar punctures (LPs) due to inappropriate management of antithrombotic medications and lack of adequate training of junior doctors in the peri-procedural man- agement of LPs encouraged us to conduct a quality improvement project aiming to address these issues.MethodsRetrospective review of day case elective LPs (01/10/2018 - 01/01/2019) Junior doctor surveys aiming to assess LP related knowledge and confidenceResults37.5% (75/200) of the scheduled LPs were cancelled due to mistakes in the pre-procedural man- agement of patients’ blood-thinning medication. Junior doctors’ knowledge of consent and antithrom- botic management was suboptimal. As was self-reported confidence and competency in independent performance of LPs at CMT/SHO level.Change implementedImplementation of Trust-approved Guidelines on peri-procedural management of LPs based on systematic review of literatureLP training clinicRe-audit.LP cancellation rate fell to 8% after implementation of these measures (15/04/2019 - 15/07/2019) with meaningful improvement in LP knowledge/confidence of junior doctors. christinamousele92@gmail.com

Reasons for day of surgery cancellation of orthopaedic cases following a major earthquake in Trinidad and Tobago.

An earthquake in 2018 resulted in irreparable damage to the Port of Spain General Hospital, Trinidad and Tobago, and severely affected orthopaedic services. This study investigates the rate and reasons for cancellation on the day of surgery of orthopaedic cases during the post-earthquake period. We prospectively collected data on all cases scheduled to undergo surgery during the study period. Information was gathered on patient demographics, the number and reasons for cancellation. Data were analysed using Analyse-it for Microsoft Excel 5.40 (Analyse-it Software Ltd). Our results show that 43 patients were cancelled, resulting in a 44.3% cancellation rate. Patients who had their surgery cancelled were older, with a higher American Society of Anesthesiologists class compared with patients whose surgery was not cancelled. Hospital-related factors were found to be responsible for the majority of cancellations. Placed in context, our findings suggest that limited operating time due to the earthquake-induced hospital damage was the principal reason for the high rate of surgery cancellations.

Short-notice cancellations of laparoscopic permanent contraception

ObjectivePermanent contraception through tubal sterilization is the preferred contraceptive method for 25% of women in the United States. Laparoscopic permanent contraception has an anecdotally high cancellation rate. Cancellations affect operating room utilization and may reflect barriers to care. We aimed to identify the short-notice cancellation (≤7 days from scheduled surgery) rate for laparoscopic permanent contraception, reasons for cancellation, and postcancellation outcomes. Study DesignWe performed a retrospective chart review of patients aged 18 to 50 who canceled or no-showed a scheduled laparoscopic permanent contraception surgery between May 2016 and May 2019 at an academic tertiary care hospital and academic county hospital in Denver, Colorado. We reviewed electronic health records to determine the time between cancellation and surgery date and documented reasons for cancellation. We evaluated contraceptive methods used and pregnancies within a year after the canceled surgery. ResultsThe overall surgery cancellation rate for scheduled laparoscopic permanent contraception was 22% (123 of 558). Short-notice cancellation occurred for 71.5% of patients and 32.5% (40 of 123) canceled same day. The most common reason for cancellation was patient choice (74%) followed by financial/insurance issues (11.4%). In the year after their canceled surgery, 22% (27 of 123) of patients obtained permanent contraception and 5.7% (7 of 123) had a subsequent pregnancy. ConclusionsAmong patients who canceled their laparoscopic permanent contraception, the vast majority canceled their surgery a week or less from their scheduled date. These short-notice cancellations may adversely affect both patients and the health care system. More research is needed on institutional policies to reduce laparoscopic permanent contraception cancellations while helping patients who want effective contraception find an option that works best for them. ImplicationsOur retrospective cohort study found that laparoscopic permanent contraception surgeries have an overall high cancellation rate at both an academic tertiary and an academic county hospital, with most cancellations occurring less than 7 days prior to surgery. Future research will be used to reduce barriers to permanent contraception while developing clinical tools to reduce surgery cancellation rates.

INCIDENCE OF CANCELLATIONS OF ELECTIVE OPERATIONS ON THE INTENDED DAY OF SURGERY AT A SUPER SPECIALITY HOSPITAL AND THEIR REASONS: A RETROSPECTIVE ANALYSIS

Background: Any elective surgical case that is scheduled on the OT list on the day prior to surgery but not operated upon as scheduled can be regarded as an elective surgical case cancellation. Case cancellation is considered a major cause of wastage of material and human resources in the hospital and has a major impact of psychological setback to patients together with their families as well. Reasons for cancellations are quite complex and vary from hospital to hospital because they are correlated to patients in that area, management of hospital, organizational issues, and other hospital and OR staff. Methods: Among 1600 participants, a retrospective hospital-based, cross-sectional study was carried out in a super speciality hospital. A selfadministered questionnaire with an observatory checklist was used for collecting and assorting data from the OR managers, case related anaesthetists, nurses, and surgeons. Results: In this study, 1600 patients were scheduled for elective surgical operations. Among those, nearly almost one-sixth 259 (16.19%) of the operations were cancelled and 1341 (83.81%) patients were operated on their planned date. The reasons for cancellation were patient related (65.3%), anaesthesia related (10%), management related (9.3%) and rest were surgeon related factors (1.2%). The cancellations happened mainly due to improper scheduling (14.3%) which were rescheduled at some other time, unavailability of surgeons (1.1%), unavailability of oxygen and blood (1.1%) and equipment (0.7%). Department wise if the study was viewed at, General surgery (27%) urology (20.8%) and orthopaedics (15.1%) were the commonest cancelled cases. Conclusion: The cancellation rate at our medical centre remains relatively low. Patient related causes, medical illness, and management related causes were the commonest reason for the cancellation of elective operations.

The Value of Preoperative Laboratory Investigations in Healthy Individuals Undergoing Elective Cataract Surgeries.

PurposeTo evaluate the number of patients with abnormal preoperative laboratory test results and determine the benefits of these tests in healthy individuals scheduled for elective cataract surgeries.Patients and MethodsThis study was conducted at Songklanagarind Hospital, Thailand. The data were collected from January 1, 2020, to August 31, 2021. The results of laboratory investigations, consisting of a complete blood count (CBC), including hemoglobin (Hb), hematocrit (Hct), and platelet count; chest X-ray (CXR); electrocardiography (EKG); and anti-human immunodeficiency virus (anti-HIV), were evaluated and analyzed. Additional management actions and rates of postponement or cancellation of surgeries were also evaluated.ResultsIn total, 401 participants were enrolled in this study. The rates of abnormal investigation results were 40.2% for EKG, 15.5% for CXR, 12.7% for Hb, 11.7% for Hct, 2.0% for platelet count, and 0.2% for anti-HIV. The preoperative tests that required additional management and postponement/cancellation of surgeries were CXR (5.5% and 1.7%, respectively), EKG (2.5% and 0.5%, respectively), and anti-HIV (0.2% and 0%, respectively). Moreover, age ≥60 years was associated with a significantly higher rate of positive preoperative EKG findings (relative risk, 4.64; p = 0.017).ConclusionThe CBC test was not beneficial as a preoperative laboratory investigation for healthy individuals in any age group who were scheduled for elective cataract surgery. However, EKG, CXR, and anti-HIV test results were valuable. Patients aged ≥60 years were at risk of having positive EKG results that could result in cancellation or postponement of surgery.

Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI

Background/Aim: No consensus on the optimal stimulation protocol for increasing in vitro fertilization (IVF) treatment's success rate in patients with diminished ovarian reserve is available. This study aimed to compare IVF outcomes in patients with diminished ovarian reserve (DOR) stimulated with a luteal phase estradiol (E2) priming protocol versus the standard antagonist protocol. Methods: This retrospective cohort study included 603 patients who underwent intracytoplasmic sperm injection cycles (ICSI) after the diagnosis of DOR and who were stimulated with the luteal E2 priming protocol (E2 priming group; n = 181) or the standard antagonist protocol (antagonist group; n = 422). Groups were compared in terms of demographic characteristics, ovarian stimulation results, ICSI cycle outcomes, clinical pregnancy, and live birth rates per embryo transfer. Results: The duration of ovarian stimulation was longer, and the total gonadotropin dose used was significantly higher (P = 0.001) in the E2 priming group than in the antagonist group. The number of embryos transferred was higher in the antagonist group when compared with E2 priming group (0.87 (0.75) versus 0.64 (0.49); P = 0.01), but no statistically significant difference in terms of embryo quality between groups was found (P > 0.05). The cycle cancellation rate, clinical pregnancy, and live birth rates per embryo transfer were similar in both groups. Conclusions: No difference between IVF outcomes in the patients diagnosed with DOR who were stimulated with the antagonist protocol and the luteal E2 priming protocol was detected. The antagonist protocol might be considered more advantageous because of the shorter treatment duration and lower doses of gonadotropin. This protocol also allows more embryos to be transferred. Additional randomized controlled trials are needed to verify these findings.

Ovarian Reserve and ART Outcomes in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Patients With FOXL2 Mutations.

ObjectiveTo characterize the status of ovarian reserve and ART outcomes in BPES women and provide informative reference for clinical diagnosis and treatment.MethodsTwenty-one women with BPES were screened for mutations in the FOXL2 gene and underwent assisted reproductive technology (ART) treatment. Indicators for ovarian reserve and ART outcomes were compared between patients with and without FOXL2 mutations. Additionally, ART outcomes were compared among patients with different subtypes of FOXL2 mutations.ResultsA total of 13 distinct heterozygous variants in the FOXL2 gene were identified in 80.95% of BPES women, including 4 novel mutations with plausible pathogenicity (c.173_175dup, c.481C>T, c.576del and c.675_714del). Compared to non-mutation group, patients with FOXL2 mutations had elevated levels of FSH (P=0.007), decreased AMH levels (P=0.012) and less AFC (P=0.015). They also had worse ART outcomes with large amount of Gn dosage (P=0.008), fewer oocytes (P=0.001), Day3 good quality embryos (P=0.001) and good quality blastocysts (P=0.037), and a higher cancellation rate (P=0.272). High heterogeneity of ART outcomes existed in BPES patients with different FOXL2 mutation types.ConclusionsBPES patients with FOXL2 mutations had diminished ovarian reserve and adverse ART outcomes. The genotype-reproductive phenotype correlations were highly heterogeneous and cannot be generalized. Genetic counseling for fertility planning and preimplantation or prenatal genetic diagnosis to reduce offspring inheritance are recommended.

Rapid implementation of telegenetic services during the COVID-19 pandemic allowed continuing patient access, but not equally for all.

Telegenetics is the use of telemedicine to deliver clinical genetic services to patients. During the COVID-19 public health emergency (PHE), telegenetics was essential for the Center of Personalized Genetic Healthcare (CPGH). This study reviews and analyzes in the context of the RE-AIM framework CPGH’s rapid implementation of telegenetics and its impact. We conducted a chart review of all out-patient telegenetics encounters scheduled in CPGH during the first five weeks of the COVID-19 PHE. Data analyzed included demographics; number of encounters scheduled; subspecialties and providers; outcome of encounter (completed, cancelled, no- show); and telehealth platform used. Data were compared to data for out-patient encounters in 2019. In the first five weeks of the COVID-19 PHE, 465 virtual visits were scheduled and 428 were completed, involving all six subspecialties and 86% of CPGH providers. The no-show plus cancellation rate was significantly lower than in 2019. By week four, CPGH’s virtual visit volume was 82% of its out-patient volume during the same time period in 2019. Patients over 60 and Black patients were significantly more likely to use phone-audio only appointments. CPGH rapidly implemented telegenetic services to continue providing care to patients. We identified success factors that enabled this. However, our analysis also identified a possible “digital divide” for Black and older patients.

Using Information Videos to Improve Patient Satisfaction in Endoscopy: A Prospective Service Improvement Project.

Background: Endoscopy is a rapidly developing discipline with new techniques and procedures being introduced each year. The consenting process is central to patient perception; using information videos as additional tools to aid consent and improve the quality of care in endoscopy is not well established. Our aim was to develop, implement and validate the use of patient educational videos to improve patients’ satisfaction and experience in endoscopy.Methods and analysis: This was a prospective service quality improvement study. Eligible patients were invited to watch the educational videos in addition to standard practice. We compared this group with a matched cohort of patients who were receiving standard care of postal information leaflets. Patient satisfaction was measured through the validated Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ).Results: Patients in the intervention group scored four questions relating to pre-procedural information significantly higher than the control (p=0.038). The total mean GESQ score was also higher in the intervention group compared to the control, however this was not statistically significant (p=0.397). The intervention group had significantly lower cancellation rate (4%) compared to the control group (20%), p=0.023.Conclusions: Patients who watched educational videos were more satisfied with pre-procedural information in the consenting period than those who did not. Further research is still needed to determine if they reduce patient anxiety. Meanwhile, it would be appropriate to implement these videos into routine practice as a cost-effective method of improving patient satisfaction.

Implementation of electronic messaging protocol for pediatric urology preoperative scheduling: A pilot study

Preparing patients for surgery is a task healthcare organizations strive to optimize. Electronic messaging (EM) provides an opportunity for streamlining components of this arduous process. Our study aims to evaluate our early experience in utilizing EM to provide preoperative information to pediatric urology patients. To assess the effectiveness of EM in preparing patients for pediatric urologic surgery. This study compared a 6-week pilot program of EM (Figure1) with traditional nurse phone calls (NPC) in preoperative instruction of pediatric urology patients. The same preoperative instructional information was provided via either source. Data collected included time and resources used by the healthcare system and patient/parent satisfaction. The EM group included 98 patients, while the NPC group included 212 patients. Case cancellation rate between the two cohorts was similar, with a 6.67% cancellation rate in the EM cohort and a 10.55% cancellation rate in the NPC cohort (z=-1.137, p=0.25). There were 4EM-related operating room delays with an average case delay of 31.5min (5-60min). Twenty-four (24%) EM patients/families required secondary phone calls, while 106 (50%) NPC required a follow up phone call (p<0.01). 94% of EM participants recommended EM for future perioperative instructions. Accounting for the average case volume within our entire children's hospital, the average total daily cost for EM is $5.96/day, as compared to an average total cost of $87.78/day to perform NPC. This represents an estimated cost savings of $81.82 per day or $21,273.20 per year, based upon average total case volume at our institution. In our initial experience, EM effectively communicates the necessary preoperative information to patients and/or families undergoing pediatric urology surgery. Our results demonstrate low case cancellation and delay rates and high patient/family satisfaction. Also demonstrated was the cost savings by replacing the NPC with EM. A great benefit of EM was the increased time it provided for nurses to perform other patient care duties, which is important given our current nationwide nursing shortage. Limitations of the study included a narrow scope assessing only pediatric urology patients as well as a short study period. Further studies will further define and refine the role of perioperative EM. Changing to an EM system for preoperative instructions in the pediatric urology population met with a high degree of patient satisfaction and decreased costs for healthcare systems without increasing case delay or cancellation rates.

A robust optimization formulation for dynamic pricing of a web service with limited total shared capacity

AbstractThis article provides a robust optimization formulation to tackle the demand uncertainty in the web service dynamic pricing problem where a provider offers a web service with different service levels (i.e., web service classes) to manage capacity and maximize profit. Consumers may buy their required web service through a reservation system and have the right with no obligation to cancel their purchases as long as they pay the penalty. In this article, we develop a robust optimization formulation for the model in which the demand of a service class is a linear function of the price; the total shared capacity of the provider for the web service is limited; the demand function coefficients and cancelation rate are time‐dependent. We demonstrate that the robust formulation is of the equivalent order of complexity as the nominal problem. Eventually, we obtain the optimality condition and some managerial insights into the problem according to the maximum principal and provide an algorithm to find the optimal pricing policy as a function of the time on a finite time horizon. Numerical analyses are performed to evaluate the effect of uncertainty on the objective function. Furthermore, the proposed algorithm is compared with some existing approaches. The preliminary results show that the proposed algorithm offers better results than other algorithms such as QCP, NLP, GA, and SA in terms of time and accuracy.

Cancelación de procedimientos quirúrgicos electivos: una agenda para la investigación en Colombia

Cancellation of scheduled surgeries is a latent problem in Colombia, which encompasses negative consequences for the patient (physically and psychologically), the health care personnel (well-being, satisfaction, performance) and the institution (cost-effectiveness). The rate of cancellation varies between 2,7 - 7,6 %. Most cancellations are preventable and occur due to administrative or programming issues. In this document, we performed a review on the gaps of knowledge on this problem in Colombia, and we highlighted some points for the research agenda.