Reasons For Cancellation Research Articles

Barriers to colonoscopy in remote northern Canada: an analysis of cancellations

ABSTRACT Background: Colonoscopy is a critical diagnostic and therapeutic procedure that is challenging to access in northern Canada. In part, this is due to frequent cancellations. We sought to understand the trends and reasons for colonoscopy cancellations in the Northwest Territories (NWT). Methods: A retrospective review of colonoscopy cancellations January, 2018 to May, 2019 was conducted at Stanton Territorial Hospital, NWT. Cancellation details and rationale were captured from the endoscopy cancellation logs. Thematic analysis was used to group cancellation reasons. Descriptive statistics were generated, and trends were analysed using run chart. Results: Of the scheduled colonoscopies, 368(28%) were cancelled during the 16 month period, and cancellations occurred, on average, 27 days after booking. Cancellation reasons were grouped into 15 themes, encompassing personal, social, geographic and health system factors. The most frequently cited theme was work/other commitments (69 respondents; 24%). Cancellations due to travel and accommodation issues occurred more frequently in the winter. Conclusion: Over one in four booked colonoscopies were cancelled and the reasons for cancellations were complex. Initiatives focusing on communication and support for patients with personal or occupational obligations could dramatically reduce cancellations. Ongoing collaborative efforts are needed to inform and optimise access to colonoscopy in this region.

Analysis of early complaints and cancellation reasons after the CPAP treatment in obstructive sleep apnea patients

Analysis of early complaints and cancellation reasons after the CPAP treatment in obstructive sleep apnea patients

A pilot study on effect of autologous platelet-rich plasma on refractory thin endometrium in frozen embryo transfer cycle

Background: During assisted reproductive technology (ART) treatments, one of the most common reasons for cancellation of the cycle is thin endometrium. Refractory endometrium which doesn’t respond to standard medical therapies can be the aetiology of recurrent implantation failure. Thin endometrium remains an unsolved problem in the treatment of infertile women. Autologous PRP is known to help tissue regeneration. Aims: To evaluate the effect of intrauterine infusion of platelet-rich plasma in case of thin endometrium and its impact on endometrial thickness and clinical pregnancy rate. Materials and Methods: Our study was prospective randomised controlled trial done from 1st October 2018 to 1st April 2019 at Reproductive Biology & IVF Centre, Maulana Azad Medical College, New Delhi, India. Twenty- four women undergoing frozen embryo transfer with history of thin endometrium (less than 7 mm) with normal hysteroscopic examination were enrolled. Patients with uncorrected asherman syndrome, submucosal polyp, fibroid or congenital uterine anomaly were excluded from study. From day 2 of menses Tab estradiol valerate (tablet Estrabet, Abott India) was started in a dose of 6–8 mg/day. It was increased up to 12 mg/day gradually after reviewing endometrial thickness serially. Patients with thin endometrium on day 10/11 received PRP on day 11 and repeat dose after 48 hours if endometrial thickness was less than 7 mm. Frozen embryo transfer was done in patients who achieved endometrial thickness 7 mm or more. Results: The mean pre-treatment endometrial thickness was 4.68±0.96 mm, which significantly increased to 6.65±0.52 mm, post treatment (P < 0.05). Four patients out of 24 in our study could not achieve an optimal pattern of endometrium after treatment and embryo transfer was postponed. The positive beta human chorionic gonadotropin rate was 55%, and clinical pregnancy rate was 45% among them. Conclusion: PRP was found to play an effective role in thin endometrium.

Magnitude of Elective Surgical Patient Cancelation and Associated Factors at Assella Teaching and Referral Hospital, Oromia Region, South East Ethiopia

Back ground: Elective surgery is a term used for non-emergency surgery which is medically Necessary, but which can be delayed for at least 24 hours. Elective surgery is usually performed in an operating theatre or procedure room under some form of Anesthesia by a surgeon. Operation theatre requires considerable human resources and expenditure from Hospital budget. Objective: To assess the magnitude of cancelation of elective operations and associated factors among elective surgical patients at Arsi University, Assella Referral and Teaching Hospital. Method: a cross sectional hospital based study was conducted at Arsi University, Assella Referral and Teaching Hospital from April 20 to June 1, 2018. The total sample size was 112 elective surgical patients Who was planned to have a surgery at ATRH. The data was collected by reviewing the daily schedule lists for elective surgery with a predesigned form. The data was analyzed using SPSS software version 20. Result: a total of 112 patients were planned to be operated during our study period; from those 36 (32.2%) was canceled. Rate of cancelation in male and female is 36.6%, 27% respectively. surgery department has the highest number of cancelation procedures 19 (52.7%) The most common reasons for cancellations were administration related from surgical side and shortage of time 17 (47.2%), medical reasons 9 (25%) and inadequate preparation of the patient 7 (16.6%). Conclusion: Cancellation of elective surgical procedures on the scheduled day of surgery was high during the study. Most of the reasons were shortage of time and management related, medical reasons and inadequate preparation of patient. Most of the reasons were avoidable.

Reduction of last-minute cancellations in elective urology surgery: A quality improvement study.

Last minute cancellations of elective surgery negatively impact both patients and hospitals, leading to inefficient use of resources, reduced capacity and increased waiting lists. The aims of the study were: to determine the last-minute cancellation rates in a tertiary urology department, to analyse the reasons driving cancellations, and to implement targeted solutions. Process mapping was used to analyse the patient journey, and a retrospective service evaluation of 6 months of urology operations was conducted. Interventions were designed based on addressing the most common cancellation reasons, and the audit cycle was completed with a further 6 months of post-intervention data collection. In the first 6 month period we reviewed, there were 2773 scheduled operations, of which 334 resulted in a last minute cancellation (12% of scheduled operations). The top four cancellation reasons were: Targeted interventions, including a reminder telephone call, resulted in a modest reduction (0.2%) in the rate of last-minute cancellations in the following 6 months. Cancelled operations represent poor use of resource. The bulk of common cancellation reasons can be addressed with a reminder telephone call covering admission instructions.

208.5: Donor card cancellation reasons in Iran.

Background: In Iran annually less than one-third of brain dead cases are donated. In 1397 around 6000 potential organs were buried whereas based on statistics daily 7-10 people on the transplant list die due to lack of organs. Awareness raising and cultural activities to increase organ donation are significantly effective. An effective factor is an organ donor card. It is reported that sometimes donor card holders, specifically teenagers, regret their registration and request card’s cancellation. This study was done to determine the most important factors affecting the donor card’s cancellation request. Methods: This was a retrospective cross-sectional study on reasons for donor card cancellation requests by people registering through ehda.center network from February 2015 until the study date of February 2019 (4-year period). All information of registered people is available through the database. People who wish to cancel their registration do so by emailing the center. For this study, 1800 emails were studied by 4 researchers. Some emails were sent twice, incomplete, or unrelated. Overall 425 emails were evaluated. Results were analyzed using SPSS21 descriptively using Pierson formula. Results: Raw information showed that in 4 years donor card requests from this network were 1409986 and 425 requested cancellation. 54.62% of card receivers were women. Demographic information is represented in table and graph 1 and 2. Results of received emails of cancellation requests are represented in table2. Based on Pearson’s deviation, there is a significant reversed correlation between age and reason for cancellation request meaning that in those at lower ages the reason for the cancellation request was family’s disapproval. (P<0.000) Conclusions: Based on results the most common reason for cancellation request has been family’s disapproval. Also, there is a significant reversed correlation between age and reason for cancellation request meaning that family’s influence on card cancellation has been greater at lower ages. Therefore awareness rising is necessary among the society and organ donation should be discussed in families. Keywords: Organ donor card, Iranian Society of Organ Donation Iranian Organ Donation Society.

2884 How Delay in Colonoscopy Impacts Diagnosis of Significant Medical Conditions

INTRODUCTION: Colonoscopy cancellations will lead to delaying diagnosis of medical conditions that may be found at colonoscopy. The delay in diagnosing a treatable medical condition can lead to unnecessary increases in patient morbidity and mortality. This study evaluates the impact of a delayed colonoscopy on diagnosing significant medical conditions and the risk factors that may predict significant findings at colonoscopy. METHODS: Retrospective study done at Sierra Nevada Gastroenterology Medical Associates and Sierra Endoscopy Center, both located in Grass Valley, California. Electronic medical records of 421 patients were reviewed from January 2016 through December 2017. Demographics, insurance, reasons for cancellations, timing of rescheduled colonoscopy, indications and significant findings of colonoscopy were recorded. RESULTS: 421 patients cancelled their colonoscopy and 223 (53%) rescheduled. 157 (70%) rescheduled their colonoscopy within 3 months. Demographics, insurance, rescheduled timing. Reasons for cancellations, indications, and findings of colonoscopy. CONCLUSION: Most patients cancel their colonoscopy without realizing the impact that may have on their health. This study shows that significant findings were diagnosed in 98 (44%) of patients, including polyps, colitis and colon cancers. Delaying the diagnosis of these conditions can lead to increased morbidity and mortality. Symptoms, indications or demographic characteristics did not consistently predict significant colon pathology. Therefore, all patients should be encouraged to follow through on their colonoscopy as quickly as possible.

242 Demographic and Historical Risk Factors Associated With Incomplete, Missed, and Cancelled Colonoscopies

INTRODUCTION: Access to colonoscopy is critical for colorectal cancer screening. Cancelled colonoscopy appointments have a major impact on overall healthcare costs, provider workflow, and delays in colorectal cancer screening and diagnosis. We aimed to discover individual and systemic factors associated with the occurrence of incomplete, missed or cancelled colonoscopy appointments at our institution. METHODS: This was a retrospective observational study using the Cleveland Clinic Florida database. Patients scheduled for screening or diagnostic colonoscopy from January to June 2018 were included. There were two case groups: those that missed or cancelled colonoscopy appointments and those that had incomplete colonoscopies due to poor bowel preparation. A control group consisted of a random sample of 200 patients that had completed colonoscopies during the same time period. We excluded patients that underwent therapeutic colonoscopies. We performed descriptive analysis within each group, univariate analysis between the control group and case groups, and odds ratio. We used a 95% CI and P-values of less than 0.05 for statistical significance. RESULTS: 4,499 colonoscopies were scheduled from January to June 2018. There were 369 (8.2%) missed/cancelled colonoscopies and 117 (2.6%) incomplete colonoscopies. Control group included a random sample of 200 completed colonoscopies. The total sample size was 686. Factors associated with a decreased risk of missed colonoscopies included white race (OR 0.56; P = 0.001), history of polyps (OR 0.52, P &lt; 0.001), previous colonoscopy (OR 0.32; P &lt; 0.0001), diagnosis of IBD (OR 0.21, P = 0.001), and married status (0.52; P = 0.001) (Table 1). Patients of black race (OR 2.1; P = 0.01) and patients with international addresses (OR 2.34; P = 0.04) were more likely to have incomplete colonoscopies (Table 2). Incomplete colonoscopies were more likely to be performed and re-scheduled than cancelled colonoscopies (67.5% vs. 44%; P &lt; 0.001). Monday was the most common day for cancellations (12.6%). Difficulty understanding or tolerating bowel preparation (39.2%) was the most common reason for cancellation (Figure 1). CONCLUSION: Patient demographics, particularly patients visiting from international locations, were major risk factors for missed and incomplete colonoscopies. Many patients appeared to have difficulty understanding bowel preparation instructions. Future efforts should be made to focus on improving bowel preparation education. This will lead to improvement in healthcare utilization.

An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole.

Operating theatres account for a significant proportion of hospital costs. There is a paucity of data evaluating utilisation of South African (SA) state operating theatres. To measure operating theatre utilisation and the rate of day-of-surgery cancellations (DOSCs) in a state hospital theatre complex. A prospective audit of a state operating theatre complex at a Durban regional hospital was performed between 26 February and 26April 2018. Times were collected for each theatre case from the entry of the patient into theatre to their departure to the post-anaesthetic care unit. This was done on weekdays between 08h00 and 16h00. The factors causing any delays and DOSCs were identified and recorded. Over the study period, 125 220 operative minutes were available for both elective and emergency operating theatres; 655 elective cases and 359 emergency cases were performed. Overall theatre utilisation was 55.2%, with actual operating time comprising only 36.9% of all available time. Non-operative time occupied 63.1% of all available time, split between late starts (9.3%), early list finishes (16.1%), changeover times (19.4%) and anaesthetic time (18.3%). The DOSC rate was 26.2%, with 232 cases cancelled on the day of surgery. Just under half of the DOSCs were avoidable. The most common reason for cancellation was lack of operative time. Measured theatre utilisation was higher than previously quoted figures for SA state hospitals, but below international benchmarks. A significant amount of time was wasted as a result of delayed first-case starts, prolonged changeovers and early terminations of lists, all of which contributed to a high DOSC rate. Before more theatre time can be made available, theatre users must first optimise use of currently available time. Further studies quantifying the effect of staff shortages in state operating theatres on inefficient use of time are required.

Same-Day Cancellation in Vascular Surgery: 10-Year Review at a Large Tertiary Care Center

Same-day cancellation of vascular surgical procedures is an undesirable occurrence with multifaceted implications into the patient's health care. Numerous factors play a role in same-day cancellations, ranging from medical causes, patient factors, or administrative and scheduling conflicts. A retrospective review of the medical records database at our large tertiary academic referral center from 2007 to 2017 was performed to identify patients scheduled for vascular surgical procedures who experienced same-day cancellation. Of the 17,887 scheduled vascular surgical procedures during the study period, 361 (2%) patients experienced same-day cancellations. Seventy-five percent of cancellations were determined to be nonforeseeable, 12.5% foreseeable, and 12.5% indeterminate. The most common reasons for cancellation were medical (55%), patient-initiated cancellation (12%), procedure no longer required (10%), and administrative or scheduling conflicts (10%). Twenty-six (7.3%) patients died within 30days after their cancelled vascular operation. Most patients (69%) eventually received the planned operation, with a mean interval of 45.5±135.8days between cancellation and performance of the aforementioned procedure. At our institution, same-day cancellations of vascular surgical procedures were infrequent (2%). Most cancellations were due to medical reasons. Although most cancellations were determined to be nonforeseeable, emphasizing foreseeable cancellations may provide opportunities to improve patient care, enhance satisfaction, and reduce future cancellations.

The Iddah Period as a Reason for Cancellation of Marriage

The iddah period is a waiting period that applies to a woman whose marriage is broken legally through a divorce or physically through the death of a husband. Any woman who has not had a prior marriage must observe the iddah period. As one of the legal conditions of marriage, failure to complete the iddah period can result in the cancellation of any secondary marriages. In this study, judges release a verdict in accordance with the laws and legislation of Indonesia, namely Law No. 1 of 1974 on Marriage and a compilation of Islamic law found in Al-Qur'an and Hadith. This article uses legal research based on positive laws including judicial decision. This study concluded that if a marriage is prohibited for a failure to satisfy the condition of iddah, that marriage must be canceled. This article employs statute and conceptual approaches to legal research, as well as case study methodology, with the aim of departing from the views and doctrines that develop in law in order to build a legal argument that addresses legal issues. Analyzing the Decision of the Mojokerto Religious Court Number 1365/Pdt.G/2014/PA.Mr, this study argues that prospective spouses are responsible for awareness of their prospective partners’ marriage eligibility and fulfillment of all requirements, material and formal, clearly stipulated in state and religious law.&#x0D; Keywords: Iddah, Islamic Law, Marriage Cancellation

Patient Reported Reasons for Surgery Cancellations Do Not Necessarily Correspond with Hospitals' Representation of the Same Problem.

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation.

Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study.

The Operating Theatre (OT) is the largest cost centre as well as the main revenue generator in most hospitals. One of the common problems affecting optimal OT utilization is the cancellation of scheduled surgeries. The goal of this study was to identify factors associated with cancellation within 24 h of scheduled surgeries in a tertiary hospital. All elective surgeries performed on adults 18 years and above between June 2015 and December 2016 were included. Cancellations ≤24 h from the scheduled start time of the surgery were recorded, with their reasons for cancellation. Data relating to the patient, surgeon and planned surgery were obtained from the hospital operational database. Univariate analysis and multivariable analysis were conducted using logistic regression. A total of 4060 scheduled surgeries were included, of which 398 (9.8%) were cancelled within 24 h of surgery. On multivariate analysis, cancellation within 24 h of surgery was associated with history of heart failure (Adjusted odds ratio, AOR1.65; 95%CI 1.08-2.50), advanced chronic kidney disease (AOR2.33; 95%CI 1.58-3.39), or a history of hip fracture (AOR2.29; 95%CI 1.33-3.80), low socio-economic status (on Medifund financing, AOR3.16; 95%CI 1.37-6.72), history of ≥4 cancelled surgeries in the past 3 years (AOR2.38; 95%CI 1.30-4.19), and scheduled time in the afternoon (AOR1.83; 95%CI 1.44-2.32) and evening (AOR2.09; 95%CI0.73-5.13), compared to the morning. Attendance at preoperative anaesthesia assessment clinic was associated with reduced likelihood of cancellation (AOR0.55; 95%CI0.43-0.72). Several patient and system factors can be used to identify scheduled surgeries that are at high likelihood of cancellation within 24 h of surgery, which may inform strategies to improve the efficiency of OT utilization, including having a dedicated preoperative anaesthesia assessment clinic.

Cancellations of elective surgical procedures due to inadequate management of chronic medications.

Inadequate management of chronic medication puts patients at risk and causes unnecessary suspension of surgical procedures. The objective of the study was to calculate the rate of cancellation of elective surgical procedures due to inadequate management of chronic medications and to analyse the underlying causes of cancellation. We designed an analytic, observational, retrospective study of all elective surgical procedures performed from July to October 2017 in a tertiary hospital. The main variable was the percentage of surgeries cancelled owing to inadequate management of chronic medications. Other variables recorded included demographic characteristics, time between the preanaesthesia evaluation and surgery, drug involved, and the reason for incorrect management of the medication. During the study period, 5415 surgical procedures were programmed, and 793 (14.6%) were cancelled. Cancellations due to inadequate patient preparation accounted for 5.3% (42 cases), and 19 were related to incorrect medication management (2.4% of the total number of cancellations). The 19 patients, who were mostly men (73.7%), had a median age of 76years (IQR 68-81). The drugs involved were acenocoumarol (6), enoxaparin (4), clopidogrel (4), direct-acting oral anticoagulants (2), acetylsalicylic acid (1), tocilizumab (1) and leflunomide (1). The reasons for drug mishandling were poor understanding of the anaesthesiology recommendations (15) and lack of a preanaesthesia evaluation (4). Inadequate management of chronic medications (2.4%) is not the most frequent reason for cancellation, although it is one of the easiest to avoid. Based on our results, starting in October 2017, the Pharmacy Department began to offer a pharmaceutical service to patients with doubts about the preoperative management of chronic medications.

Elective Case Cancellation on the Day of Surgery at a General Hospital in Sarajevo: Causes and Possible Solutions.

Introduction:Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services.Aim:The aim of the research was to determine the percentage and reasons for cancelling elective procedures and provide adequate measure to reduce this number in the future and to identify ways to improve the patients’ satisfaction level.Material and Methods:This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included.Results:Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital “Abdulah Nakas”, 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery (33.51%), surgery cancelled due to medical/anesthetic reasons (31.38%), surgical procedure cancelled by the surgeon on the day of surgery (11.97%).Conclusion:This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

Influence of Preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) on Bacterial Colonization of Biliary Tract in Patients Surgically Treated for Obstructive Jaundice.

Introduction:Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services.Methods:This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included.Results:Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital “Abdulah Nakas”, 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery, (33.51%), surgery cancelled due to medical/anesthetic reasons, (31.38%), surgical procedure cancelled by the surgeon on the day of surgery, (11.97%).Conclusion:This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

Cancellation Criteria of Acute Rehabilitation: Rehabilitation Risk Management.

This study aimed to investigate risk management during acute rehabilitation in cases where rehabilitation was canceled after prescription. Rehabilitation cases that were judged to be canceled after prescription in our hospital between April 1, 2017, and September 30, 2017, were investigated prospectively. The following parameters were examined: the total number of canceled rehabilitation therapies, the age and sex of the patients, the rehabilitation categories, the reasons for cancellation of rehabilitation, the clinical course after cancellation of rehabilitation, the number of cancellation cases with reasons corresponding to the cancellation criteria from the officially issued guidelines of the Japanese Association of Rehabilitation Medicine, and the applicable elements of the cancellation criteria. Of the 2263 patients prescribed rehabilitation during the investigation period, rehabilitation was canceled in 110 (4.9%). The reasons for discontinuation were changes in vital signs in 53.6% of these 110 patients. Among the 21 patients in whom rehabilitation was stopped because of decreased oxygen saturation, six were found to have symptomatic pulmonary thromboembolism. In 92.8% of canceled cases, the reasons for cancellation corresponded to the cancellation criteria of rehabilitation. No serious adverse events were noted during the study period. The judgments of discontinuation of rehabilitation in this study were similar to the cancellation criteria of rehabilitation. Acute rehabilitation should be performed under the control of the cancellation criteria of rehabilitation.

Hypertension as a reason for cancellation of elective surgical cases on day of surgery: A five year audit report from The Aga Khan University Hospital Karachi.

To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue. The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered. Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) woman. Overall age range was 30-77 years. Among the cancelled cases, 3(27.3%) each belonged to neurosurgery and general surgery, 2(18%) each to orthopaedic and urology, and 1(9%) to ear, nose and throat surgery. Hypertension as the primary reason for cancellation was low. Further reductions in these cancellations can be done by emphasis on following guidelines and their dissemination through continuing medical education.

Maximizing operating room efficiency by effectively managing elective case cancellation

Background: Surgery cancellation and rescheduling affect efficiency and satisfaction, both critical aspects of the modern orthopaedic practice. The purpose of this study was to critically and comprehensively evaluate cancellations to define actionable ways to improve efficiency, with the goal to develop evidence-based, transparent rescheduling policies. Methods: A retrospective review was completed of all patients who were scheduled for elective surgery over 1 yr. Outcome measures included rate of cancellation, interval from time of cancellation to scheduled surgery date, risk factors for cancellation, re-schedule rate, re-cancellation rate, and risk factors for re-cancellation. Results: There were 7,215 elective surgeries, 13% of which were cancelled prior to surgery. Forty-four percent of surgeries were cancelled within 3 days of the surgery. Of those that were cancelled, 53% were rescheduled, 21% of which had cancelled again, which was significantly higher than the comparison group of first-time cancellations. Those that were cancelled without a correctable reason had significantly more re-cancellations and a lower procedure completion rate. Conclusions: When scheduling surgeries, it is more efficient to preference surgeries that have not been previously cancelled, and among previously cancelled surgeries to preference those with a correctable reason for cancellation. While not novel concepts, this study provides an evidence base for rescheduling policies, which can be made transparent for patients. Ultimately, this may improve efficiency as well as patient trust and satisfaction.

Barriers to Colonoscopy in an Uninsured Patient Population—A Quality Improvement Project

Colorectal cancer remains common, with the "80 per cent by 2018" initiative proposed by the National Colorectal Cancer Roundtable. This study was designed to examine obstacles for patients who did not receive their scheduled colonoscopy, focusing on the impact of insurance status. Retrospective chart review was carried out on patients who did not complete their colonoscopy as scheduled from January 2013 to June 2017. The control group consisted of patients who completed their scheduled colonoscopy. One hundred and seventy five patients missed 200 colonoscopies. The most common reasons for cancellation were patient illness (16%), no-show (14%), no prep carried out (13%), inadequate prep (10%), and no transportation (11%). The canceled patients were significantly more likely to have the combination of no insurance and no Primary Care Provider (PCP) (13% vs 4%, P = 0.008), personal history of cancer (22% vs 12%, P = 0.02), and higher rates of prior GI issues (78% vs 50%, P < 0.001). The canceled group had a significantly lower history of colon polyps (37% vs 53%, P = 0.006). Difficulty with the bowel prep in addition to lack of insurance and poverty likely does create a barrier, even in a system that has a safety net, atop other issues such as transportation and inability to miss work playing a role.