Case Cancellation Research Articles

A Prospective Study of Case Cancellation at a Tertiary Care Centre

A Prospective Study of Case Cancellation at a Tertiary Care Centre

Critical patient safeguards for ambulatory surgery centers.

The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures. Patient considerations go beyond physical status and include psychosocial factors. Ensuring patients understand preoperative instructions is crucial to decrease case cancellation rates and facilitate efficiency. Pediatric patients require special considerations including extra attention to preprocedure and postoperative care and instructions, PALS-certified staff, pediatric equipment and medications, as well as heightened awareness of respiratory complications. Procedural concerns start with the capabilities of the facility such as equipment, pharmacy, and staffing for each phase of care. However, nuances such as patient throughput in a given day, emergency preparedness, and after-hours staffing will affect both patient safety and staff morale. This article outlines the issues leaders need to consider to ensure patient safety in ambulatory surgery centers.

Surgery scheduling in flexible operating rooms by using a convex surrogate model of second-stage costs

We study the elective surgery planning problem in a hospital with operating rooms shared by elective and emergency patients. This problem is split in two distinct phases. First, a subset of patients to be operated in the next planning period is selected and the selected patients are assigned to a block and a tentative starting time. Then, in the online phase of the problem, a policy decides how to insert the emergency patients in the schedule and may cancel planned surgeries. The overall goal is to minimize the expectation of a cost function representing the assignment of patient to blocks, case cancellations, overtime, waiting time and idle time. We model the offline problem by a two-stage stochastic program, and show that the optimal second-stage costs can be approximated by a convex piecewise linear surrogate model that can be computed in a preprocessing step. This results in a mixed integer program which can be solved very fast, even for large instances of the problem. We also describe a greedy policy for the online phase of the problem, and analyze the performance of our approach by comparing it to both heuristic methods or approaches relying on sampling average approximation (SAA) on a large set of benchmarking instances. Our simulations indicate that our approach can reduce the expected costs by as much as 30% compared to heuristic methods and it can solve problems with 1000 patients in about one minute, while SAA-approaches fail to obtain good solutions within 30 min on small instances.

Assessing the Anaesthetic Time on Operation Theatre Utilisation and Case Cancellation

The time to perform an anaesthesia-related procedure at induction and emergence is often overlooked as part of the operation theatre (OT) utilisation time. This prospective observational study aimed to assess the estimation done by the surgeons and anaesthetists on anaesthesia times and the overall OT utilisation in our centre. This prospective observational study included elective cases from 13 surgical disciplines. The trainees, specialists and consultants from surgical and anaesthesia teams estimated the anaesthesia times separately before the surgical procedures. The actual anaesthesia, surgical, total procedural and turnover durations taken to complete the cases were documented. Operation theatre utilisations of those various surgical disciplines involved in the study were also analysed. We analysed 128 elective cases. The average mean time spent for anaesthesia procedures was 28.4 ± 14.1 min, with the mean induction time was 16.0 ± 9.8 min and the mean emergence time was 12.5 ± 8.6 min. Both anaesthetists and surgeons overestimated the anaesthetic times, but anaesthetists estimated closer to the actual anaesthetic times (r = 0.64 vs r = 0.49, respectively). There was no significant difference in the estimated anaesthetic times between different experience levels. All the surgical disciplines had average OT utilisation exceeding 90%, indicating overutilisation. A total of 12 cases (7.1%) were cancelled. Most cases were cancelled due to exceeded allocated block OT times (7 cases) or unavailability of ICU beds (2 cases). We concluded that OTs exceeding the given OT time is the most frequent reason for cancelling elective surgical cases on the day of surgery.

Estimating Surgical Duration for Surgeries: Towards an Efficient Schedule of Operating Theatre

Poor operation theatre (OT) scheduling is a common cause of case cancellation on the day of surgery. We analysed the accuracy of anaesthetists and surgeons in estimating the surgical time to complete an operation and investigated whether the estimated times was correlated with the actual surgical time. It was a prospective observational study with 369 elective cases from various surgical subspecialties which were performed within three months in a tertiary university hospital. Anaesthetists and surgeons were required to estimate the surgical time of the elective cases before the day of surgery. Their estimations were compared with the recorded actual surgical time. The primary outcome was the median time difference from the estimated surgical time. Anaesthetists accurately estimated surgical times of 82 cases (22%) and surgeons 59 cases (16%). Overall, anaesthetists overestimated the surgical time by 11 minutes of actual surgical times [interquartile range (IQR) -15 to 40 minutes]. Surgeons underestimated their surgical time by 15 minutes [IQR -60 to 20 minutes]. The median estimated surgical time difference between anaesthetists and surgeons was significantly different (p<0.0001). Among the surgical subspecialties, the longest overestimation by anaesthetists was up to 48 minutes in colorectal surgeries. The most underestimated median time difference by surgeons was 65 minutes, seen in upper gastrointestinal surgeries. A significant strong positive correlation existed between overall anaesthetists' estimated and actual surgical times (rs = 0.735, p<0.0001). At the same time, there was a weak correlation between surgeons’ overall estimation time upon booking and actual surgical times (rs = 0.492, p<0.0001). In conclusion, both the anaesthetists and surgeons were significantly inaccurate in estimating the duration of surgical procedures. Although the anaesthetists tended to overestimate it while surgeons underestimated it, their estimations correlated strongly with the actual surgical times, whereas surgeons’ estimations were weakly correlated.

The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.

Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.

Case cancellations and associated factors on the day of surgery in hospitals of Wolaita Zone, South Ethiopia

BackgroundCancellations of elective surgery cases are frequent and have significant negative consequences. It causes wasting of valuable resources, patient unhappiness, and psychological stress of patients. Despite this, little is known about the case cancellation and associated factors on the day of surgery in Ethiopia, particularly in the study area.ObjectiveThis study aimed to assess the magnitude of case cancellation and associated factors on the day of surgery in hospitals in Wolaita zone, South Ethiopia, from May 17 to June 17, 2023.MethodsA hospital-based cross-sectional study involving 322 patients was conducted at Wolaita Sodo Zone, South Ethiopia. All elective surgical cases scheduled during the study period were included. The entire number of participants was selected using a systematic random sampling process. Epidata V.3 was used to enter data, and SPSS V.25 was used to analyze it. Binary logistic regression was used to check for a possible association. P-values < 0.05 and 95% CI were used on multi-variable analysis as the threshold for the significant statistical association.ResultA total of 313 study participants were scheduled for elective surgical procedures during the study period and gave a response rate of 97.2%. The mean (± SD) age of the study participants was 39.18 (± 10.64) years. The two-third of patients, 53(64%) were rural residents, and more than half (178, or 55.3%) of the participants were female. This finding showed that the case cancellation was 22.4% (95% CI: 19.3 -25.9%). Among the total canceled cases, 49(58.3%) were males. Variables like rural residence (AOR = 3.48 95% CI: 1.22–9.95), Lack of lab result (AOR = 2.33, 95%CI:1.20–4.51), ophthalmology dept. (AOR = 2.53 95% CI:1.52–4.49), HTN (AOR = 2.53, 95% CI:1.52–4.49), patient refusal (AOR = 3.01 95% CI:1.22–5.05), and age b/n 31 and 43 (AOR = 1.50, 95% CI:1.02–2.01) were significantly associated factors with cancellation of elective surgical cases.ConclusionIn this study schedule of case cancellation was high. The contributing factors of case cancellation were rural residence, Lack of lab results, ophthalmology dept, HTN, patient refusal, and age. To decrease unnecessary cancellations and increase cost efficiency, hospital administration and medical staff must plan ahead carefully, communicate effectively, and make efficient use of hospital resources.

Clinical outcome of organ‐cultured preloaded DMEK compared to standard DMEK ‐ A single center study

The use of ready‐to‐use grafts from specialized eye banks might provide a number of benefits, including graft quality control, assured availability at a certain operation time, a decreased likelihood of case cancellation, and a shorter and less sophisticated DMEK surgery, with a resulting lower risk of graft damage. However, it is critical to thoroughly establish the clinical safety of employing these preloaded tissues. Especially since most of the studies were prepared and stored under hypothermic conditions. There are only a few studies on preprepared tissues in organ culture, which are partly controversial.In this prospective study we included patients who received DMEK surgery at the Knappschaft Eye Clinic Sulzbach between 05/2021–12/2022. Patients received either a preloaded DMEK (pDMEK), prepared 5 days before surgery in the eye bank, or a conventional, directly before surgery, surgeon‐prepared DMEK (sDMEK).The preliminary data shows that preloaded DMEK is a safe procedure, but there is a trend towards more frequent rebubbling in the pDMEK group and a statistically non‐significant lower postoperative endothelial cell count compared to the sDMEK group. However, visual acuity and corneal thickness reduction were similar in both groups.

Patient Selection Criteria for Improving Quality and Safety in Patients Undergoing Ambulatory and Day-Care Surgery

Abstract Introduction: With advances in monitoring, anesthesia, and minimally invasive techniques, same-day surgeries are expected to rise significantly in the coming years. In this group, patients undergo diagnostic and therapeutic procedures and are sent home on the same day. This poses a great responsibility on the doctors involved and the hospital services, in ensuring the absence of delays, unanticipated admissions, and unexpected adverse events. Patient selection criteria are being used effectively by various centers across the world to prevent elective case cancellation and unplanned hospital admission and identify high-risk cases for major complications including morbidity and mortality. In recent year patient selection criteria, based on the latest guidelines, are being used to identify the risk factors and channel patients for ambulatory, day-care, and inpatient categories. Aims and Objectives: This article purposes a proper patient selection process for the improvement of quality and safety in patients undergoing day-care and office-based procedures. The patient selection criteria, if understood by all the team players, is instrumental in providing clinical guidance and appropriate patient triaging for caring for an ever-increasing, large volume of same-day surgical population. As the volume and complexity of the patient population grow, it is important to revise the patient selection criteria from time to time. Conclusion: Patient selection criteria have to be developed and modified by bodies and institutions to suit local circumstances to channel patients for ambulatory, day-care, and inpatient categories. Processes, administrative, clinical, and technical standards must be in-built into place and the pathway need to be well understood by all the team players in an institution.

Profile of orthopaedic day-case procedures at a district general hospital (retrospective study)

BackgroundThe outcomes of orthopaedic day-case procedures have been reported widely, but there is a lack of reports from secondary health facilities such as district hospitals.AimWe aimed to perform a retrospective analysis of patient records to capture the profile of day-case procedures performed.Materials and methodsWe conducted a retrospective analysis of day-case procedures at the dedicated Day Surgery Unit of a moderate-sized district hospital in Saudi Arabia between January 2021 and December 2022. The medical records of all the patients who had day-case procedures by the hospital's orthopaedic unit were analyzed.ResultsWithin the study period, 71 out of 914 elective orthopaedic procedures were carried out as day-cases, giving a day-case surgery rate of 7.8%. The mean age was 25.3 ± 12.2 (range, 4–55 years), and the male-to-female ratio was 6:1. The spectrum of the procedures was dominated by implant removal in 59 cases (83.1%). Whilst the anaesthetic technique varied, all the patients were ASA class I or II. There were minor complications in 10 patients (14.0%), with 7 of them (9.8%) needing inpatient admission. There was no cancellation of cases in our study.ConclusionWe found day-case procedures to be safe and effective but with low utilisation of the Day Surgery Unit, which can be improved through the development of a detailed protocol for day surgery in the hospital.

Pediatric influenza vaccination in the perioperative setting: A quality improvement project.

Unmet need for seasonal influenza vaccination administration to pediatric patients exists at national and local levels. Vaccination during the perioperative period remains controversial, though opportunity exists to meet vaccination need through perioperative programs. The initial SMART Aim of this quality improvement initiative was to establish and increase seasonal influenza vaccination rate in eligible patients during in person preoperative clinic visits in a pediatric perioperative surgical home (PSH) to 10%. Informed by each prior season's experience, we increased our SMART Aim target for vaccinations in seasons two and three to 15 and 18%, respectively. Following the Model for Improvement methodology, the PSH team developed and implemented a perioperative pediatric influenza vaccination program. Across three influenza seasons, key interventions included updates to organizational perioperative vaccination policy, obtaining material influenza vaccination supplies, development of EHR tools, PSH staff education, and communication with patient-families. Rate of eligible patients receiving influenza vaccination at their PSH clinic appointment was tracked over time. Influenza vaccination rates were reported monthly during Season 1, then weekly during seasons two and three. The balancing measure was same day surgery case cancellations related to influenza vaccination given at PSH clinic appointment. Statistical analysis methods utilized include Shewart's control chart and statistical process control (SPC) standards. Special cause variation was determined by eight or more consecutive data points above or below the centerline. The influenza vaccination rates in each of the three influenza seasons exceeded vaccination rate goals of 10, 15, and 18%, respectively. A total of 695 vaccines have been administered since program inception. No same day surgical case cancellations were observed as balancing measure. Over three consecutive influenza vaccination seasons, we safely established and met vaccination rate goals of 10, 15, and 18% to eligible patients during preoperative clinic visits within a pediatric PSH system. Through iterative PDSA cycles, we continue to identify opportunities for future improvement. This suggests that the perioperative period presents opportunity for seasonal influenza vaccination with potential program expansion to include routine vaccines of childhood.

Technology used to enhance medication awareness/visibility in electronic health record: Multi-disciplinary collaboration and impact on perioperative procedural patient safety.

470 Background: Many patients undergoing procedures at MD Anderson are diagnosed with conditions necessitating anti-coagulant medications taken in the perioperative timeframe. Holding these medications prior to surgery is essential to avoid perioperative complications and procedural delays/cancellations. Failure to hold anti-coagulants could delay necessary cancer treatment. Hypothesis presented: implement a technology solution to enhance the awareness and visibility of these medications within the electronic health record (EHR) to assist in alerting multi-disciplinary care team members. With increased awareness across the perioperative clinical care team, cancellations/delays are expected to improve. Methods: In the fourth quarter of 2020 (* mark in data below), perioperative anesthesia and information technology (IT) teams collaborated to create a visual banner “watch meds” in the EHR. Banner is easily visible above the summary of each patient’s medication list. An institution wide education and awareness campaign highlighting “watch-meds” banner was done by anesthesia/surgical/perioperative teams. Patients meeting the following criteria were identified in the EHR: diagnosis necessitating anticoagulation, anticoagulant use, and scheduled OR procedure. Delays and cancellations on the procedure day for patients meeting criteria from 1/1/2020-12/31/2022 were analyzed, comparing pre and post implementation effects. Results: Case delays and cancellations impact time and labor resources, lead to equipment and material waste, and delay cancer care. Timely surgical completion carries tremendous impact on patient safety, satisfaction, and resource preservation. The number of patients who met criteria for the banner warning was 8% of the total number of cases throughout the three-years recorded. Of those who met criteria, 62% resulted in case delays. Implementation of the banner warning resulted in an immediate 2-fold improvement in cancellations, and ultimately demonstrated a 3-fold stable improvement. Conclusions: Leveraging technology to enhance visual cues in the EHR can be a powerful tool to relay important patient information including medications affecting perioperative care to all care team members, thus enhancing patient safety.[Table: see text]

908 Factors Affecting Last Minute Cancellation of Elective General Surgical Cases; Preliminary Findings of a QIP

Abstract Introduction Waiting lists for elective general surgeries have been growing steadily over the past few years, with short-notice cancellations affecting both cost and patient safety. There are currently nationwide incentives to cut referral-to-theatre delays and tackle the backlog of over 7 million patients (NHS backlog data analysis - British Medical Association 2022). Aim To identify common causes of short-notice cancellation of elective general surgery lists, and identify targets for intervention for minimisation. Method This audit was registered with the department. Prospectively collected elective general surgery lists between January and November 2022 were compiled and analysed. We coded the reason for cancellation from patient records. For the patients found to be unfit on the day to come in (TCI), we reviewed PAC notes to see whether they had been deemed fit at PAC and how this had changed. Data were coded and analysed on Microsoft Excel on secure Trust computers. Results Between 01/01/2022 and 06/11/2022, 508 (22%) of the scheduled 2300 cases were cancelled, with 235 (10.2%) within 48 hours of their scheduled start date. Acute patient illness and patient unavailability were the most common causes of short notice cancellation of a case (n = 41), followed by time constraints (n = 33), patients not being medically optimised (n = 27) or no longer requiring surgery (n = 21, as well as administrative error (n = 14). Conclusions Targets for intervention following these preliminary audit results included improved patient literature at pre-assessment, clerical chart review in the lead up to the surgery to ensure all administrative tasks have been performed, and a clinical review immediately prior the TCI date to identify any intercurrent illness.

206 Impact of theatre cancellation on surgical training

Abstract Introduction The COVID-19 pandemic has had significant consequences on healthcare delivery worldwide, with a particular impact on surgical services and training. In preparation for the influx of COVID cases, non-urgent appointments, investigations, and operations were cancelled. As a result of the cancellation of cases, elective and emergency case exposure was inevitably reduced. Over 65 percent of trainees lost all training and only 9% reported that they would meet the essential skills. One in eight trainees in their final year have had their training extended due to failure to meet curricular requirements, while a quarter of trainees reach their final year behind their planned training trajectory. The primary objective was to identify the case with the highest cancellation rate to perceive its impact on surgical training. Method This is a retrospective study of data gathered by Department of eHealth in a tertiary hospital. Data collected from December 2020 to September 2021were analysed. Results 121 elective cases were cancelled over the course of 9.5 months. More than thirty types of elective operations were cancelled, with Laparoscopic cholecystectomy - 33 (27.3%) and EUA rectum - 10 (8.3%) being the two most often cancelled procedures. Twenty percent (n=20) of the cancelled cases were malignant. Conclusion The recovery of surgical training requires a joint effort from all – the trainers, the trainees and those involved in the delivery of surgical training. The training opportunities for trainees of any grade should be maximised in the theatre setting along with other training opportunities focussed on specific index procedure.

A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment.

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m2, who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.

The Golden Patient Initiative: A Systematic Review.

Operating theatres and surgical resource consumption comprise a significant proportion ofhealthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE),Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented amonglocal trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.

Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations

IntroductionThe Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. MethodsWe conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. ResultsA total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). ConclusionsOur results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.

MP72-15 PREOPERATIVE MEDICAL CLEARANCE: UNVEILING PRIMARY CARE NEEDS AT A PUBLIC URBAN MEDICAL CENTER USING UROLOGIC CASE CANCELATION RATES

You have accessJournal of UrologyCME1 Apr 2023MP72-15 PREOPERATIVE MEDICAL CLEARANCE: UNVEILING PRIMARY CARE NEEDS AT A PUBLIC URBAN MEDICAL CENTER USING UROLOGIC CASE CANCELATION RATES Lauren Fink, Matthew Bruha, Frederick Okoye, Lauren Namkoong, Brian McNeil, and Llewellyn Hyacinthe Lauren FinkLauren Fink More articles by this author , Matthew BruhaMatthew Bruha More articles by this author , Frederick OkoyeFrederick Okoye More articles by this author , Lauren NamkoongLauren Namkoong More articles by this author , Brian McNeilBrian McNeil More articles by this author , and Llewellyn HyacintheLlewellyn Hyacinthe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elective surgical case cancelations are a common problem in healthcare, causing patient and staff dissatisfaction, and a financial burden on institutions. Underserved communities have unmet primary care needs, and case cancelations in these populations may reflect chronic disease burdens. We evaluate the role of urologic consultation in improving overall health by identifying undiagnosed or undermanaged conditions during preoperative evaluation METHODS: All canceled elective urologic procedures from two surgeons at one urban center were retrospectively analyzed from 1/2015-12/2019. Chart reviews were performed to obtain reason(s) for cancelation, demographics, medical interventions performed, and American Society of Anesthesiologists (ASA) score pre- and post-operatively. Age-adjusted odds ratio (OR) was calculated for the association between preoperative ASA and medical interventions RESULTS: 1780 total elective cases were scheduled in our review. 551 canceled elective cases were identified with a 30% overall cancelation rate. 250 of those canceled cases were due to >1 undiagnosed or under-managed medical condition(s), representing 14% of the overall cancelation rate. 91.2% of patients were over 60 years old and African American. Notes were available for 111 (44.4%) of the 250 total cases canceled due to undiagnosed or under-managed medical conditions. 83% of these patients received their intended procedures. 35.1% of cases received medication adjustments, most commonly for cardiology and diabetes. Preoperative ASA>3 was found to be significantly associated with medical interventions of any kind (OR 2.6923 [1.1188-6.4788] p=0.0271) CONCLUSIONS: Elective urologic case cancelations were frequent and often related to comorbid conditions. Most patients canceled for medical reasons received optimization and then underwent surgery. ASA scores>3 may assist urologists in underserved urban areas in identifying patients who require medical intervention before elective surgery. Urologic consultation and subsequent preoperative clearance seem to provide a safety net for patients to receive optimization of their medical conditions that otherwise might go unmanaged. Case cancellations can have economic effects, also. Procedure slots are difficult to fill in on short notice. This paired with a high cancelation rate prevents opportunities to generate revenue. Appropriate consultation can eliminate pitfalls by allowing patients to obtain preoperative clearance prior to scheduling their elective cases Source of Funding: SUNY Downstate Medical Center © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1030 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Fink More articles by this author Matthew Bruha More articles by this author Frederick Okoye More articles by this author Lauren Namkoong More articles by this author Brian McNeil More articles by this author Llewellyn Hyacinthe More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature.

The authors conducted a systematic review on the effect of coronavirus disease 2019 on electrophysiology (EP) practice and procedure volume in various settings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase were examined with combinations of medical subject headings terms for identification of the relevant studies. After excluding duplicates, irrelevant, and ineligible studies, 23 studies were included for full qualitative analysis. The overall study-level volume reduction of EP procedures ranged from 8 to 96.7%. All studies reported an overall reduction in EP physiology procedures being carried out except one in Poland, which reported an overall increase in the total EP procedures carried out in 2020. This study still reported a decrease in EP procedure volume during the first lockdown phase. Procedural volume reduction was seen most commonly for cardiovascular implantable electronic device placement (20/23 studies, 86.9%), electrophysiology studies (11/23 studies, 47.8%), and ablations (9/23, 39.1% studies). The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). There has been an overall reduction in EP procedure volume across different centers. The impact of the decline in EP procedures will be seen only after the services resume to prepandemic levels, but an increase in-patient volume and procedure waiting time is expected. This review will provide insights into improving healthcare service delivery in times of unprecedented public health emergencies.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.