Case Cancellation Research Articles

Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis.

Many day-of-surgery cancellations are avoidable, and different strategies are used to prevent these costly adverse events. Despite these past analyses and evaluations of positive interventions, studies have not examined the final disposition of patients whose cases were canceled in this late manner. This study sought to determine whether surgical procedures canceled for medical or anesthetic reasons were ultimately rescheduled, and the time elapsed between cancellation and completion. In addition, the resolution of the underlying issue leading to cancellation was examined. Two years of surgical case data were reviewed in the electronic health record to isolate all procedures canceled on the intended operative date. These cases were then filtered by the documented reason for cancellation into 2 categories: 1 for cases related to medical or anesthetic care and 1 for unrelated cases. Medical- or anesthetic-related cases were further categorized to better elucidate the underlying reason for cancellation. Cases were then traced to determine if and when the procedure was ultimately completed. If a case was rescheduled, the record was reviewed to determine whether the underlying reason for cancellation was resolved. A total of 4472 cases were canceled in the study period with only 20% associated with medical or anesthetic causes. Of these, 72% were rescheduled and 83% of all rescheduled cases resolved the underlying issue before the rescheduled procedure. Nearly half of all cases (47.8%) canceled on the day of surgery for reasons linked to medical and/or anesthetic care were due to acute conditions. Nearly a fifth of cases that are canceled on the date of surgery are never rescheduled and, if they are rescheduled, the delay can be substantial. Although the majority of patients whose procedure are canceled for reasons related to medical or anesthetic care have resolved the underlying issue that led to initial postponement, a significant portion of patients have no change in their status before the ultimate completion of their surgical procedure.

Improving the Pre-Admission Testing (PAT) Through Informatics Enhancement

<h3>Introduction</h3> At Mercy Medical Center (MMC) the Pre-Admission Testing (PAT) Department ensures diagnostic documents (DD) required by the Anesthesia are in the Chart by the Day of Surgery (DOS) to facilitate the perioperative process. Missing pre-operative diagnostics can lead to DOS OR Case Cancelations due to an identified medical reason and/or a need for medical clearance. These cancelations are problematic for the patient and the organization. <h3>Identification of the Problem</h3> Following the implementation of an Electronic Medical Record (EMR) in the Fall of 2018, the PAT Staff recognized difficulties locating the DD in the patient's EMR. This decrease was resulting in an elevated DOS Cancelation Rate "due to medical reasons" which reached a high of 1.6% in September 2018. A need for EMR Enhancement was identified along with a focused collaboration with the Surgical Team. <h3>QI question/Purpose of the study</h3> Does collaboration with EMR Analysts and Leadership improve availability of DD within the EMR increase the efficacy of PAT staff to complete pre-surgical charts and result in a decrease of case cancellations on DOS? / To improve the integration process of DD in the EMR thus reducing DOS cancellations by 0.8 % in 1 Year. <h3>Methods</h3> Collaboration with the EMR Analysts and Leadership to fine-tune the EMR to increase the ability for PAT staff to complete the presurgical chart. <h3>Outcomes/Results</h3> The targeted goal was to decrease the DOS Cancelations "due to medical reasons" to be below 1.6%. In September of 2020* the DOS Cancelations "due to medical reasons" reached 0.7%. *The COVID Pandemic impacted the final stages of implementation and delayed outcome data. <h3>Discussion</h3> Collaborations with the PAT Staff, Specialty Offices, and Leadership took place February to July 2019. PAT Staff also met with the EMR Analysts to enhance the EMR. The changes made to the EMR workflow for scanning DD were implemented. <h3>Conclusion</h3> Continued collaboration with PAT Staff, Informatics, the Surgical Team, Anesthesia Providers, and Leadership is key to ensure the required DD are present in the EMR to decrease the chance of a DOS Cancelation due to medical reasons. <h3>Implication for Perianesthesia nurses and future research</h3> Continuous monitoring, evaluation, and collaboration with the entire team are essential to consistently improve patient safety and preparedness for the DOS.

Evaluation of a Novel Multidisciplinary Preoperative Workup Strategy for Geriatric Hip Fractures.

To determine the financial and clinical impact of a standardized, multidisciplinary team for surgical clearance and optimization in geriatric hip fracture patients. Retrospective case series. Level-1 trauma center. One hundred twenty-four geriatric patients (age >65 years old) in the preprotocol group (cohort 1; January 2017-December 2018) and 98 geriatric patients in the postprotocol group (cohort 2; October 2019-January 2021) with operative hip fractures. Implementation of a multidisciplinary team protocol consisting of Anesthesiology, Internal Medicine and Orthopedic Surgery departments for the assessment of medical readiness and optimization for surgical intervention in geriatric hip fractures. Rate of cardiology consultation, need for cardiac workup (echocardiography stress testing, heath catheterization), time to medical readiness (TTMR), time to surgery, case-cancellation rate, length of stay (LOS), and total hospitalization charges. Following implementation of the new protocol, there were significant ( P < 0.001) decreases in TTMR (19 vs. 11 hours), LOS (149 vs. 120 hours), case cancellation rate, and total hospital charges ($84,000 vs. $62,000). There were no significant differences with respect to in-hospital complications or readmission rates/mortality rates at 1 year. Following implementation of a protocolized, multidisciplinary approach to optimizing geriatric fracture patients, we were able to demonstrate a reduction in unnecessary preoperative testing, TTMR for surgery, case cancellation rate, LOS, and total hospitalization charge-without a concomitant increase in complications or mortality. This study highlights that standardization of the perioperative care for geriatric hip fracture patients can provide effective patient care while also lowering financial and logistical burden in care for these injuries. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

P09 The golden patient initiative: a systematic review

Abstract Introduction Operating theatres and surgical resource consumption comprise a significant proportion of all healthcare costs. Inefficiencies in theatre lists remain an important focus for cost management. During COVID-19 pandemic, the number of patients on theatre waiting lists has surged. Hence there is a pressing need to utilise already limited theatre time and fraught resources with innovative methods. In this systematic review we consider the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aimed to assess its overall efficacy. Methods A literature search using four databases: MEDLINE, CINAHL, EMBASE, and the Cochrane library identified all clinical research concerning the GPI. Two independent authors screened articles against eligibility criteria, using a process adapted from PRISMA guidelines. Data extracted included outcomes measured, follow-up period and study design. The result displayed significant heterogeneity; therefore a narrative review was conducted. Results 13 of 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 of theatre start time was reported (P&amp;lt;0.05), as was a statistically significant decrease in case cancellations. Conclusion Our analysis gives encouraging conclusions for theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings. However, at present it is largely implemented amongst local trusts, hence larger multicentre studies are required to provide conclusive evidence. Take-home message Our analysis gives encouraging conclusions for greater theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings.

Cancellation of Elective Cases in Songklanagarind Hospital: Identification of Reason: A Retrospective Study

Background: The operating theatre is the most important department of a hospital as it involves significant resources. One of the significant obstacles in overseeing a theater managing system is scheduled elective case cancellation. Objective: The present study was conducted to identify preventable reasons for cancellation. Materials and Methods: A retrospective study was conducted between January and December 2018. Data from scheduled elective cases were retrieved from a database of the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. All patients who required anesthetization for surgery were divided into two groups, proceeding with the operation, and case cancellation. Baseline characteristics of the two groups were compared using the chi-square test, Fisher’s exact test, and analysis of variance. All statistical analyses were performed using the R software, and the correlation was considered significant at p of less than 0.05. The reason for case cancellations was categorized into three groups, preventable, unpreventable, inconclusive, then displayed as percentages. Results: In all, 12,423 patients were identified as being scheduled elective cases. The case cancellation rate was 6.4%. Cancellation rates of males and females were 7.3% and 5.6%, respectively. Patients aged 65 to 79 years exhibited a 7.6% cancellation rate, and the cancellation rate was the highest at 17.3% in the American Society of Anesthesiologists (ASA) physical status classification 4. Of the 797 canceled surgeries, 397 cases (50%) were preventable, 192 cases (24%) were unpreventable, and 208 cases (26%) involved inconclusive reasons. The preventable reasons for cancellation comprised incomplete medical evaluations in 179 cases (22.5%), overtime in 74 cases (9.3%), and the patient refused surgery in 52 cases (6.5%). Conclusion: The most common cause of elective case cancellation is an incomplete preoperative evaluation, which is a preventable reason.Therefore, preoperative evaluation protocol as a one-stop service preoperative clinic should be established to prevent and decrease the cancellation rate of elective cases. Keywords: Cancellation case; Elective surgery; Preventable reason

Contributing Factors of Elective Surgical Case Cancellation: A Cross- Sectional Descriptive Study

Introduction: Elective surgical case cancellation refers to a scheduled surgical procedure that not performed on a given day. Cancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. It has been a long-standing problem for healthcare organizations across the world. Methods: This was a cross-sectional observational study conducted from September 01 to November 30, 2021 for a period of three months in a 750-bedded tertiary care hospital, Kathmandu. A cancelled procedure was defined as a patient’s name appearing on the list for surgical operations but the operation not being performed on the scheduled date. Patients scheduled for surgical procedures were recruited into this study by the principal investigator and research assistants on the day prior to their operation. Results: Of total 600 patients scheduled for elective procedures over a period of three months, the prevalence of cancellation of elective surgical procedures was found to be 15.33 % (n=92). Of the examined surgical specialties, the cancellation prevalence was highest in GI and HPB at 40.9% (n =47), closely followed by Urosurgery at 31(33.6%), general surgery17(18.47%), plastics, Paediatric surgery 5(5.4%) and burn and plastics surgery 2 (2.1%) having the least cancellationrate at 2(2.1%) which was statistically significant (p value&lt;0.05). Conclusions:Inadequate preoperative preparation, prioritized emergency cases and equipment shortages are the common causes of elective surgical cancellations.

Audit of operation theater time utilization with perspective to optimize turnaround times and theater output.

Operation theater (OT) complex is an important area for a hospital as it needs expensive infrastructure, disposable, and reusable resources and a multidisciplinary highly qualified and efficient team, the metrics of which are key in generating revenue, and improved productivity. The efficient utilization of OT ensures maximum output in view of the investment of highly qualified doctors, equipment, and outcomes. Our study aimed to evaluate the utilization of OT functioning stepwise, reasons for delays, case cancellations, and areas of improvement if any. This prospective observational study was planned in three phases; in phase 1 audit of OT functioning was carried out for 1 month and based on data analysis recommendations were given for improvement. In phase 2, the recommendations would be implemented over 3 months and in phase 3 re-audit will be carried out for 1 month. Data analysis was done on IBM SPSS version 26 software. Descriptive statistics measures were calculated by the mean and standard deviation. The total available resource time was 52920 min and the total time utilized was 37740 min. Overall, raw utilization was 71.31%. OT was started late 63.50% times. Case cancellation occurred on 8.99% occasions. We conclude that utilization of operating room time can be maximized by proper planning and realistic scheduling of elective lists, communication among team members, and resource management. Audit of OT utilization is an important tool to identify problem areas and formulate protocols accordingly.

Telemedicine Visits Can Generate Highly Accurate Diagnoses and Surgical Plans for Spine Patients.

A Retrospective cohort study. To (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery. Data on capability of telemedicine to deliver high-quality preoperative assessment without a traditional in-person interaction and physical examination is lacking. Records of patients who had a new patient telemedicine visit and indicated for surgery with documented specific diagnosis as well as surgical plans from a spine department at an urban tertiary center from April 2020 to April 2021 were reviewed. For a subset of patients that had a follow-up in-person evaluation before surgery, these diagnoses and plans were compared. Perioperative outcomes were compared between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery. A total of 166 patients were included. Of these, 101 patients (61%) only had a new patient telemedicine visit before surgery while 65 (39%) had a telemedicine visit followed by an in-person evaluation. There were no differences in the rate of case cancellations before surgery and patient-reported outcome measures between these two groups ( P >0.05). Of 65 patients who had both a telemedicine followed by an in-person visit, the diagnosis was unchanged for 61 patients (94%) and the surgical plan did not change for 52 patients (80%). The main reason for surgical plan change was due to updated findings on new imaging, 10 patients, (77%). The current study suggests that telemedicine evaluations can provide an effective means of preoperative assessment for spine patients. Level 3.

Social Work Advocacy in Federal Immigration Courts

Advocacy for immigrant families undertaken by social workers, attorneys, and other supporters to protect against deportation, detention, and unfair government policies occurs mostly in immigration and federal courts. Social workers bring unique knowledge and skills that enhance legal teams’ representation of immigrants. This paper provides case illustrations of social work’s contribution in three types of legal actions. One illustration from immigration court demonstrates the social work consultant’s role in cancellation of removal cases when undocumented immigrants have US-citizen children. A second case is a federal class-action lawsuit to end the detention of asylum-seeking families. The third case was a federal lawsuit to dismantle bureaucratic policies and procedures that undermined the legal rights and well-being of unaccompanied children. In each of these actions, social work knowledge influenced lawsuits that can have lasting policy impact. While this paper focuses on social work advocacy in immigration cases, social work extends to many other areas of advocacy in the legal system. Social work consultants must have a clear understanding of what the attorneys are requesting to ensure that they have the requisite knowledge and skill to be optimally effective and to practice ethically within the scope of their expertise. Other implications include maintaining familiarity with contemporary social and behavioral research and providing expertise confidently in written reports and oral testimony in court. When social workers bring their expertise to legal teams in immigration cases, they promote the profession’s expertise and help families facing oppressive policies.

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.

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.

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.

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.

The impact of acute surgical unit rostering on National Emergency Access Targets during the COVID-19 pandemic: a single hospital experience.

BackgroundSurgical departments have been dramatically impacted by the novel coronavirus 19 (COVID‐19) pandemic, with the cancellation of elective cases and changes to the provision of emergency surgical care. The aim of this study was to determine whether structural changes made within our facility's surgical department during COVID‐19 altered National Emergency Access Target (NEAT) times and impacted on patient outcomes.MethodsEmergency surgical cases over a 4‐month time period were retrospectively collected and statistically analysed, divided into pre‐ and mid‐COVID‐19 pandemic.ResultsBaseline characteristics between the groups were comparable. There was a significant increase in consultant presence in theatre in the COVID group. There were also statistically significant reductions in NEAT times at each timepoint, although these did not meet national guidelines. There was no change in emergency surgical workload, complication rate or mortality rates within 30 days.ConclusionAny significant change to services requires a coordinated hospital‐wide approach, not just from a single department, and clinicians must continue to be wary of benchmarked times as the overall feasibility and safety of NEAT times has also been highlighted again.

The Cancellation of Grants in The Perspective of Civil Law and Islamic Law

From birth, there is no human being in this world who can live alone without another human being. This is because humans are social beings. In life with human beings must be mutual helping. Forms help please this is diverse that there is a form of Services, Sale, Buy, Gift and so forth and one form of help please that there is a form of Grant. Indeed, all humans will die. This event will lead to inheritance in a civil law. Usually heirs while still alive give grants or donations either to his heirs or to others. And usually the grant is not known by the heirs, which then raises the issue of the heritage property. Thus came the issues and also the questions about how the civil law regulates the grant in the Civil Code. So in this paper will explain what grants and grant cancellation and examples of cases that occurred in Indonesia related to the problem of grants.

Inventory Optimization in the Perioperative Care Department Using Kotter's Change Model.

Perioperative services have been scrutinized in the context of cost containment in health care, particularly in the procurement and reprocessing of surgical instruments. Although solutions such as surgical instrument inventory optimization (IO) have been proposed, there is a paucity of literature on how to implement this change. The purpose of this project was to describe the implementation of an IO using Kotter's Change Model (KCM). This study was conducted at a tertiary academic hospital across the four highest-volume surgical services. The IO was implemented using the steps outlined by KCM: (1) create coalition, (2) create vision for change, (3) establish urgency, (4) communicate the vision, (5) empower broad-based action, (6) generate short-term wins, (7) consolidate gains, and (8) anchor change. This process was evaluated using inventory metrics, operational efficiency metrics, and clinician satisfaction. Total inventory was reduced by 37.7%, with an average tray size reduction of 18.0%. This led to a total reprocessing time savings of 1,333 hours per annum and labor cost savings of $39,995 per annum. Depreciation cost savings were $64,320 per annum. Case cancellation rate due to instrument-related errors decreased from 3.9% to 0.2%. The proportion of staff completely satisfied with the inventory was 1.7% pre-IO and 80.0% post-IO. This is the first study to describe the successful implementation of KCM to facilitate change in the perioperative setting. This success contributes to the growing body of literature supporting KCM as a valuable change management tool in health care.

Cancellation of Elective Surgeries in A Tertiary Care Hospital in North India

Background: Cancellation of elective surgical treatments is a quality-of-care issue as well as a huge waste of health-care resources. Patients may experience emotional distress as a result of this, as well as difficulty for their families. Aim: To find the significant reasons of cancellation of scheduled surgical cases. Methods: A total of 300 elective operations in our institution were chosen. The completed surgeries were planned on the scheduled operation day, and the anaesthesiologist noted down a list of cancellations along with their reasons. Results: A total of 300 patients were scheduled for surgery. A total of 60 patients were cancelled, resulting in a 20% cancellation rate. Lack of operational time was the most prevalent reason for cancellation. Conclusion: The majority of the reasons for cancellation should have been avoided with proper list preparation and the surgical team's meticulous planning.

EP.FRI.992 Milking the COW: A pilot study of seven-day consultant working

Abstract Aims The Five Year Forward View, predicts a funding gap of nearly £30 billion per year by 2020/21, with continued disparity in resources and healthcare demand. Further, the view describes ever widening gaps in three main domains of healthcare; prevention, quality and efficiency. Those domains raised are echoed in the efficient operative working of a general surgical service with an aged, co-morbid population and inefficient theatre utilisation with increasing case cancellation due to lack of bed space. In 2012, the Academy of Medical Royal Colleges recommended patients have the same standard of care seven days a week, with consultant review ‘at least once every twenty-four hours’. In general surgery, will a seven-day consultant led working model with a ‘consultant of the week’ (COW) enable more rapid and appropriate decisions to be made for patients enabling their efficient treatment and reducing length of stay. Method A retrospective analysis of hospital length of stay and mortality before and after the implementation of a consultant led weekday and weekend service in general surgery was carried out looking at data in October 2017 and 2018. Results The introduction of enhanced seven-day working is associated with reductions of one fifth in length of stay but no difference in mortality. Conclusions Whilst statistically significant associations with the COW and reduced length of stay have been made, the clinical significance of one fifth of a day may be negligible. Continued data collection over a longer time period, prospectively will increase the power of the study.

Using Predictive Bed Planning to Reduce Case Cancellations and Create Growth Opportunities in High Occupancy Academic Health Systems

Using Predictive Bed Planning to Reduce Case Cancellations and Create Growth Opportunities in High Occupancy Academic Health Systems

Preoperative assessment clinics and case cancellations: a prospective study from a large medical center in China.

BackgroundPreoperative assessment clinics have great benefits in reducing surgical cancellations, saving hospital resources and improving patient satisfaction. However, previous studies did not focus on patients with comorbidities. With advancements in medicine and aging population, the number of elderly patients with multiple comorbidities is increasing. This study was designed to assess the effectiveness of a preoperative assessment clinic for patients with multiple comorbidities.MethodsThis prospective, observational study enrolled patients with multiple comorbidities from Nov 1, 2019 to Oct 31, 2020 in a tertiary teaching hospital in China. Patients either visited the preoperative assessment clinic before admission or received an anesthesia consultation after admission. The impact of clinic visits on operating room cancellations, length of hospital stay before surgery, length of hospital stay after surgery, major postoperative complications, incidence of postoperative intensive care unit (ICU) admission, readmission to any hospital within 30 days after surgeries and total in-hospital costs were analyzed.ResultsA total of 326 eligible cases were included. Eighty-seven of 108 cases who visited the clinic before admission were scheduled for selective surgeries. In all, 218 patients received an anesthesia consultation after admission. The cancellation rate in the inpatient group was 7.80%, while no surgeries were cancelled in preclinic group (P=0.016). A preoperative assessment clinic visit statistically decreased the length of in-hospital stays before surgery from 93.02 to 76.11 h (P=0.010). After propensity score matching, significant differences in operating room cancellations (0 vs. 6.48%; P=0.015) and length of stay before surgery (76.11 vs. 92.22 h; P=0.038) persisted between two groups. No significant differences between the two groups were found in terms of prognosis, including major postoperative complications, incidence of postoperative ICU admissions, and readmissions to any hospital within 30 days (P>0.05).ConclusionsAmong patients with comorbidities undergoing major surgeries, a preoperative assessment clinic visit was more efficient than an anesthesia consultation after admission. These findings may provide impetus for the opening of preoperative assessment clinics for critical patients in China.