Elective Case Cancellation Research Articles

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.

COVID Stressed, but Not due to the Virus

IntroductionAcute care surgeons can experience posttraumatic stress disorder (PTSD) due to the cumulative stress of practice. This study sought to document the potential impact of the COVID-19 pandemic on PTSD in acute care surgeons and to identify potential contributing factors. MethodsThe six-item brief version of the PTSD Checklist-Civilian Version (PCL-6), a validated instrument capturing PTSD symptomology, was used to screen Eastern Association for the Surgery of Trauma members. Added questions gauged pandemic effects on professional and hospital systems–level factors. Regression modeling used responses from attending surgeons that fully completed the PCL-6. ResultsComplete responses from 334 of 360 attending surgeons were obtained, with 58 of 334 (17%) screening positive for PTSD symptoms. Factors significantly contributing to both higher PCL-6 scores and meeting criteria for PTSD symptomology included decreasing age, increased administrative duties, reduced research productivity, nonurban practice setting, and loss of annual bonuses. Increasing PCL-6 score was also affected by perceived illness risk and higher odds of PTSD symptomology with elective case cancellation. For most respondents, fear of death and concerns of illness from COVID-19 were not associated with increased odds of PTSD symptomology. ConclusionsThe prevalence of PTSD symptomology in this sample was similar to previous reports using surgeon samples (15%-22%). In the face of the COVID-19 pandemic, stress was not directly related to infectious concerns but rather to the collateral challenges caused by the pandemic and unrelated demographic factors. Understanding factors increasing stress in acute care surgeons is critical as part of pandemic planning and management to reduce burnout and maintain a healthy workforce.

Reduction of In-Hospital Preoperative Waiting Time of Elective Surgeries in the Amidst of COVID-19 Pandemic: Experience from Ethiopia.

BackgroundThe higher demand for surgical services during the advancement of the COVID-19 pandemic has resulted from the need for a pre-admission negative result, the need for extra resources, and a shortage of skilled expertise. This quality improvement project aimed to reduce the in-hospital preoperative waiting time of elective cases to less than 24 hours.MethodsThe study was conducted in a tertiary care center. Following the collection of baseline data, we formed a multidisciplinary team to analyze the root causes and intervention ideas of delay using fishbone and driver diagrams, respectively. We prioritize key drivers and implemented several low-cost interventions using Plan-Do-Study-Act (PDSA) model. We monitored the average in-hospital preoperative waiting time of patients.ResultsOverall, in-hospital preoperative waiting time for elective cases has been reduced from a baseline of 4.89 days to 1.32 days on average by the end of 10 months of initiating the project. Similarly, monthly elective case cancellation rate due to COVID-19-related reason has been reduced from baseline 62.5% of the total cancellation to 0%. Due to this, the average monthly inpatient bed utilization has increased from 2.21 patients per month during pre-COVID-19 period to 5.9 patients per month in each bed of the surgical ward by the end of the project.ConclusionThe implementation of a quality improvement project can optimize operation theatre efficiency, inpatient bed utilization, and reduce the surgical backlog. Meticulous and rigorous effort has to be laid down to do root cause analysis, generate feasible change ideas, and continuous follow-up, and testing of multiple PDSA cycles is required to impact an improvement and sustain it in the long run. The emergence of COVID-19 pandemic could be used as an opportunity to reduce the length of stay in the hospital.

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

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.

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.

Dynamics of Elective Case Cancellation for Inpatient and Outpatient in an Academic Center

Unexpected surgical cancellation is common and can have significant adverse effects. Cancellation rates vary because of a lack of a standard definition, different patient populations and study methodology. We hypothesized that case cancellation has a different pattern in a dedicated ambulatory surgical center compared to a general operating room (OR) setting in a large academic center without an anesthesia preoperative evaluation center necessitating evaluation by the various surgeons. Elective cases in general OR and in the ambulatory surgical center were included in this study. Elective cases are defined as the non-emergent cases scheduled before 8:00 am on the day of surgery. A cancelled case was defined as a scheduled procedure which is not performed on the scheduled procedure day. Case cancellation was monitored in real time using an electronic patient flow system (Navicare). As soon as the case is cancelled, the reason for the cancellation was obtained from the surgeon, the anesthesiologist, the OR coordinated nurses and/or the floor nurse. In the day surgical center, the cancelled cases were followed to determine whether/when they were rescheduled. 4261 elective cases were included in this investigation, including 2751 cases in the general OR and 1510 cases in the ambulatory surgical center. A total of 283 cases (6.6%) were cancelled which include 206 cases from the general OR and 77 from the ambulatory surgical center. The cancellation rate in the general OR was 7.5%, among which inpatients have the highest cancellation rate of 18.1%, followed by outpatients at 4.6%, and same day admission at the lowest cancellation rate of 2.0%. The top 3 reasons for cancellation in general OR werein adequate preoperative preparation 29.4 ± 4.5%, medical condition change 28.5 ± 10.2%; and scheduling issue 20.2 ± 7.1%. Most (59.2 ± 8.9%) of the cancellations was considered preventable, 12.3 ± 5.9% was considered potentially preventable, and 28.5 ± 10.2% were not preventable (such as patient condition changes). The cancellation rate in the ambulatory surgical center was 5.1%. The major reason for cancellation was patient no show 75.8 ± 5.2 %, 61% of those no show patients were rescheduled and the mean delay in surgery was 18 days (range from 1 day to 84 days). Case cancellation is not un-common in a large academic center without a preoperative evaluation clinic. The dynamics of case cancellation are different in an ambulatory surgical center as compared to the general OR. Inpatients have the highest cancellation rate associated with inadequate preoperative preparation and scheduling, this should be preventable via adopting proper systems of evaluation and preparation. Most of the case cancellations in the ambulatory surgical center are from patient no show, suggesting that administrative strategies to reduce this issue should be implemented. The patients admitted on the same day of surgery had the lowest cancellation rate requiring minimal intervention.