Same-day Cancellation Research Articles

Exploring the rate and reasons for same-day cancellation of cardiac surgery after implementing joint commission international standards: a retrospective cross-sectional study

BackgroundSame-day cancellation of cardiac surgery significantly impacts operating room management efficiency, which can be mitigated by taking preventive measures. This study aimed to explore the same-day cancellation rate of elective adult cardiac surgery, as well as the reasons for those cancellations. A retrospective cross-sectional study reviewed the records of 581 scheduled elective adult cardiac surgical cases at a single cardiac center from June 2017 to May 2018. The same-day cancellation reasons were grouped into four broad categories: nonclinical cancellations, clinical cancellations, patient-related cancellations, and 'other reason' cancellations. A case was considered canceled when it was not performed on the same day as the planned surgery.ResultsA total of 581 elective adult cardiac surgeries were scheduled during the study period, and 56 (9.63%) of these were canceled. The highest cancellation rate was due to nonclinical cancellations, with 39% of scheduled cases, followed by clinical cancellations, with a 34% cancellation rate. Patient-related cancellations accounted for 23% of cancellations, while the lowest rate was due to ‘other reasons,’ which accounted for 4% of total cancellations. The most common reason for nonclinical cancellations was the inclusion of emergency cases (n = 8; 14%). The most common reason for clinical cancellations was changes in the patient’s medical condition (n = 8, 14%). The common reason for patient-related cancellations was the refusal of surgery (n = 9; 16%). The lowest rate was for menstruating female patients (n = 2; 4%).ConclusionsThe same-day cancellation rate was 9.36%, and most of the cancellation reasons could be mitigated by implementing preventive strategies to improve the efficiency of the operating room. Preoperative preparation clinics and paying particular attention to female patients scheduled for surgery might reduce the rate of elective cardiac surgery cancellation.

8. Same-day Cancellation by Blackpool Victoria Hospital Oral and Maxillofacial Surgery Department

The aim of this audit is to investigate the reason for, and the frequency of same-day cancellations in the Oral and Maxillofacial Surgery department of the Blackpool Victoria Hospital. This will hopefully provide a greater understanding of why procedures are cancelled on the day and may allow the implementation of improvements to reduce waiting times for surgery.

Evaluation of the Effect of Changing the Normalised Appointment Mode During the Coronavirus Disease 2019 Epidemic on the Development of Day Surgery.

To investigate the effect of changing the normal appointment mode on day surgery. From December 2020 to December 2021, 302 patients with day surgery admitted to the hospital by using the unified reservation mode of the intelligent bed system were selected as the experimental group, while 302 patients with day surgery admitted to the hospital by using the decentralised bed reservation mode were randomly selected as the control group. The same-day surgery cancellation rate, bed utilisation rate and patient satisfaction were analysed and compared between the two groups. The treatment experience of the patients in the experimental group was higher than that in the control group. The same-day surgery cancellation rate was lower than that of the control group, with a statistically significant difference (P < 0.05). The unified computer reservation mode of the intelligent bed reservation system is superior to the decentralised reservation mode across departments. A daytime intelligent bed reservation mode was adopted for unifying bed appointments, which could effectively reduce the same-day cancellation rate of day surgery, improve bed utilisation and improve patient satisfaction.

Day of surgery cancellation in total shoulder arthroplasty: an analysis of surgical cancellation etiologies

BackgroundCancellation of elective total shoulder arthroplasty (TSA) is an expected occurrence. The typical cost of canceled elective surgeries is estimated to be $3000 per patient and can lead to hospital losses of nearly $1 million per year. With the growing interest of same-day TSA, understanding and minimizing unexpected same-day cancellation will reduce impact on patients, surgeons, and health care system. The purpose of the study is to identify the frequency and causes of unexpected same-day cancellations in TSA and determine which treatment path those patients take following their cancellation. MethodsA consecutive series of 1189 TSA (anatomic and reverse) patients operated at a single-academic institution across two tertiary care hospitals from 2010 to 2020 were reviewed. All patients who were scheduled for TSA and subsequently canceled were identified. The etiology of cancellation, time to rescheduling, date of actual TSA procedure, and subsequent work-up were recorded. Descriptive statistics of the canceled patient cohorts were analyzed. Univariate analysis, chi-square test, and analysis of variance were used to compare patients who canceled on the day of surgery (DOS) to prior to surgery. ResultsOf the 1189 TSA patients, 964 were TSA for primary glenohumeral osteoarthritis or cuff tear arthropathy. Ninety-eight (10.2%) TSA had cancellations, of which 49.0% were on the DOS. Most common causes of DOS cancellations were due to medical reasons (45.8%) and anesthesia-related complications (27.1%). Infection (40.9%) was the most frequent medical reasons for cancellations. Fifty-four percent of the anesthesia-related complication cancellations underwent additional diagnostic and therapeutic intervention, despite 100 % of those patients receiving preoperative clearance. DiscussionDOS cancellations in TSA are unavoidable, but there are modifiable factors that can minimize the risk of cancellation. Contrary to studies that attributed cancellations to inadequate cardiovascular-related medical clearance, our study found that the majority of these cancellations are due to infection-related issues. A higher proportion of patients with inadequate medical clearance will cancel prior to the DOS. Despite preoperative optimization, certain patient risk factors need additional diagnostic and therapeutic interventions prior to undergoing shoulder arthroplasty. Through coordination and planning, health care providers and patients can identify those factors and address these issues early on to avoid cancellation and ultimately proceed with a TSA.

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists.

Introduction Surgical site infections (SSIs) are a universally dreaded complication of any surgical procedure. The goal of this single-center study was to examine the issue of orthopaedic instrument wrapping defects with a focus on the importance of a high level of surveillance to enable identification of these defects in order to reduce the risk of instrument contamination. We also evaluated the impact on patient care, theatre staff, hospital finances and resource utilization during a defined study period in order to stimulate critical discussion and further research into potentially eliminating this problem via change in practice and advances in technology. To the best of our knowledge, this will be the first paper that looks at this problem from the above perspective within the United Kingdom National Health Service. Methods We conducted a prospective service evaluation project over a 30-week period from December 2021 to July 2022 across our three hospital sites within the United Kingdom National Health Service.We collated data on defects found in orthopaedic instrument wrappings as detected by visual inspection under ambient or theater lighting and the resulting surgical case cancellations. Defect types included in the study were all puncture holes, abrasions or tears visible to the naked eye irrespective of their size. Results A total of 601 orthopaedic sets were rejected during the study period due to defects identified in the sterile instrument wrappings. Of these, 437 were due to holes/tears in the wrapping, 129 were due to wet inner wrappings and 35 were due to insecure wrappings. This directly resulted in same-day cancellation of 13 surgical cases or 0.27% of booked cases with extra sets required for the other affected cases. These 13 cases could not proceed as they involved loan kits where no remedial action could be taken. Remedial action was required for the other 588 operation list cases affected by the sterile wrapping defects. The majority of the identified defects and resulting theatre case cancellations (61.5%) were in hip and knee arthroplasty surgery. The calculated potential financial loss due to these problems was £145,000 over the seven-month study period. This financial cost is equivalent to the best practice top-up tariff in England for treating approximately 108 hip fracture patientsbased on £1,335 per patient. Conclusion Our study identified defects in the sterile instrument wrappings affecting both the inner with or without involving theouter wrapping layerand resulting in cancellation of elective and trauma orthopaedic cases with resultant clinical and financial implications. There is a need to be more vigilant in identifying defects in drapes. Further research is warranted to improve ways of identifying defects in sterile wrappings and devise new protective mechanisms during sterilisation that can eliminate the use of sterile instrument wrappings.

Same-Day Cancellation is Higher in Outpatient Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy.

PurposeSafety and efficiency of ambulatory pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients is worthy of attention, since patients always have severe systemic diseases. The purpose of this study was to compare the incidence of same-day cancellation of PPV for PDR between outpatients and inpatients and to analyze the causes of cancellations.Patients and MethodsThis is a retrospective review of consecutive PPV procedures for PDR from January 2019 to April 2021 at either the ambulatory or the inpatient surgery center in an academic tertiary referral center. Data on patient surgery plan, same-day surgical cancellation and follow-up were recorded. Differences in cancellation rate and reasons for cancellation (e.g. medical factors, patient reasons and administrative problems) between outpatients and inpatients were compared.ResultsIn total, 1810 consecutive PPV procedures of 1367 patients were identified; 1509 (83.4%) were managed as inpatient surgeries and 301 (16.6%) as outpatient surgeries. The total same-day cancellation rate was 5.2% for all patients. Although outpatients were younger (51 years vs 52 years, P < 0.001), had less proportion of hypertension (60.5% vs 74.0%), coronary artery disease (10.0% vs 18.8%), renal insufficiency (9.3% vs 18.0%) and cerebrovascular diseases (1.0% vs 11.4%) (all P < 0.001), had less proportion of patients with ASA III status (14.9% vs 27.4%, P < 0.001), and had higher proportion of regional anesthesia with MAC (19.9% vs 5.0%, P < 0.001), the cancellation proportion was significantly higher for outpatients than inpatients (12.3% vs 3.8%, P < 0.001). Overall, the most common reason for surgical cancellation was medical factors, occurring more frequently in outpatients than inpatients (91.9% vs 68.4%, P = 0.012).ConclusionSame-day cancellation is higher in outpatient pars plana vitrectomy for proliferative diabetic retinopathy. To reduce ambulatory surgery cancellations, it is important to strengthen the monitoring of preoperative systemic comorbidities and adjust medication if necessary.

Reducing same-day cancellations of precious CT simulation slots: A quality improvement project.

301 Background: CT simulation (CTsim) is a prerequisite step in radiotherapy treatment. Each successfully completed CTsim brings a patient a step closer to receiving their radiotherapy. A non-attempt or unsuccessful attempt (both reflected as cancellations) also delays radiotherapy for another patient. Baseline data revealed that 33% of CTsim appointments were cancelled, of which 47% occurred on the same day. Cancellations made on the same day provides little reaction time for slots to be allocated to another patient and leads to inefficiency in resource utilisation. This project aims to reduce the cancellations occurring on the same day from 15.5% to 10% within 6 months at National University Cancer Institute radiotherapy center at Tan Tock Seng Hospital. Methods: A cause-and-effect diagram was constructed to identify reasons attributing to existing same-day cancellations. Multi-voting and Pareto analysis were conducted to identify 3 main root causes. Interventions were introduced and then tested using the Plan-Do-Study-Act approach. Run chart was used to monitor the proportion of same-day cancellations over the total number of CTsim appointments. Results: Three root causes identified were 1) no workflow to check on patient’s adequacy of preparation leading up to CTsim 2) no workflow to identify potential non-attendance 3) no take-home information detailing CTsim process. Interventions introduced included establishing workflow to assess adequacy of patients’ preparation required for successful CTsim and integrating a screening phone call to confirm patient’s attendance two days prior to CTsim appointment day and handing out information sheet detailing instructions for CTsim respectively. We achieved our target in our fourth month and sustained the results for 2 further months. Mean was 5% in the last three months. This reduction of same-day cancellation improves efficiency in resource utilisation and reduces delay in access to radiotherapy. Conclusions: Using quality improvement tools, we have successfully reduced the same-day cancellations of our precious CT simulation slots from 15.5% to 5%.

Moving the Needle on Patient Cancellations Through Mobile Integration

The Annie application (Annie app) prompts patients to track and guide their adherence to colonoscopy bowel prep protocol referred to as nothing by mouth (NPO) instructions. The app is a series of timed educational text messages geared toward colonoscopy preparation. This quality improvement project aimed to establish whether implementing a short message service (SMS) application (Annie app) would decrease the same-day cancellation rate among individuals receiving a nonemergent colonoscopy in a large Houston hospital clinic. Most same-day cancellations are related to failure to follow NPO instructions provided by the clinic nursing staff. All patients received the standard 14-day call, as well as the 3-day nurse reminder calls. The Annie app SMS was in addition to the standard nurse reminder calls. There were significant associations between using the Annie app and cancellations. Cancellation rates decreased by 21% when patients elected to receive the Annie app messages versus receiving voice-mail-only messages. African American individuals benefitted the most from the Annie app decreasing from 28.4% to 17.9%.

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

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

Assessing Quality and Safety of an Advanced Practice Provider-led Active Surveillance Clinic for Men with Prostate Cancer.

We implemented an advanced practice provider (APP)-led clinic to aid in managing the growing population of men on active surveillance (AS) for prostate cancer. Our objective was to evaluate the quality and safety of an established APP-led AS clinic by comparing outcomes with urologist-led biopsies, defined in terms of adherence to scheduled visits and biopsy complications. We performed a retrospective review of 2341 consecutive patients treated in an AS clinic at a high-volume referral center between 2000-2019. We examined the rate of no-show or same-day cancellation of visits for APPs versus urologists and compared the risk of biopsy complications between these providers. Generalized estimating equations were used to account for repeated visits and biopsies. There were significantly more no-shows at APP visits (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.16-1.70, p <0.001); however, this only amounted to one no-show every 41 visits. There was no evidence of increased biopsy complications with APPs (OR 0.37, 95% CI 0.05-2.49, p =0.3). Patients were not prospectively assigned to APP or urologist management; therefore, unmeasured patient differences could bias our results. We demonstrated that in an established APP-led AS clinic at a high-volume center, APPs achieved acceptable patient adherence to scheduled visits and biopsy complications. Because patients were not continuously managed by one type of provider, further prospective studies are needed to establish equivalent pathologic outcomes in APP-managed AS.

The virtual pediatric perioperative home, experience at a major metropolitan safety net hospital

Successes from anesthesiologist-led perioperative surgical homes in the adult patient population have inspired similar initiatives by pediatric hospitals. Typically the care coordination for these perioperative homes is run through hospital-funded, on-site, preanesthesia clinics. Preliminary data from pediatric perioperative homes have shown promising results in improved patient outcomes and decreased length of hospital stay. The majority of pediatric surgeries within the country are performed in nonpediatric hospitals. Such centers may not have the infrastructure or financial resources for a freestanding pediatric preanesthesia clinic. Faced with this situation at the largest safety net hospital in New England, the authors present their experience designing and implementing a "Virtual Pediatric Perioperative Home," a telemedicine-based triage and preanesthetic optimization for pediatric patients at Boston Medical Center, Boston, MA. A retrospective chart review of all pediatric anesthesia cases at Boston Medical Center from February 1, 2019, to January 31, 2020, as well as the number of pediatric cases canceled or postponed on the day of surgery for any reason during the same time period was conducted. From February 1, 2019, to January 31, 2020, 1546 anesthetics were performed in children 18years and under. Of those, 63 were designated as emergent and hence excluded from our analysis. 153 of the total 1483 (9.4%) of nonemergent bookings were canceled or postponed on the day of surgery. This represented a marked decline from our previous year's 13.7% same-day cancellation rate for pediatric patients. The most common reason for case cancellations (41.8%) was acute illness. Cancellation rates varied from month to month, with the highest cancellation rate of the year in September 2019 (18.8%). The departments of Podiatry and Gastroenterology represented the highest cancellation rates as a denominator of their case volumes, 15.4% and 15.2%, respectively. Younger children had 2.4 times the odds (95% CI: 1.720, 3.4) of cancellation compared to older children. The virtual pediatric perioperative home (VPPH) may benefit quality of care while decreasing costs to pediatric patients, families, and hospital systems. While direct financial gains may be difficult to demonstrate, the VPPH has the potential to reduce OR delays and same day cancellations related to questions of medical optimization. In the context of a socioeconomically disadvantaged patient population, our VPPH's team of subspecialists created inroads for at risk children to establish or reestablish care for their comorbidities, while collaboration with the Department of Children and Families further streamlined communication and consent for pediatric patients in foster care. The authors describe the design and successful implementation of a telemedicine-based pediatric preanesthesia triage and medical optimization service at a large safety net hospital. By creating a communication network of pediatric subspecialists, the anesthesiologists were able to, at minimal institutional cost, coordinate care for children with a variety of comorbidities leading up to the day of surgery. This yielded a 9.4% same day cancellation rate in a complex, socioeconomically disadvantaged pediatric patient population at a general hospital.

Same-day cardiac surgery cancellations at a large UK centre and patient satisfaction survey

Background: Same-day cancellation of cardiac surgeries is a disheartening experience for patients. The primary aims of this study were to determine the frequency and reasons for same-day cancellations, and associated patients’ outcomes. The secondary aims were to evaluate patients' reactions to cancellations and to propose measures to reduce cancellations.Methods: We prospectively reviewed all elective and urgent in-patient adult cardiac surgeries performed from August 2017 to March 2018. Procedures were divided into cancelled (C) and not cancelled (NC) groups. A qualitative patient satisfaction survey was undertaken.Results: Overall, 1388 patients were scheduled for cardiac surgery during this period. Elective surgeries constituted 70.7% (981/1388) and urgent 29.3% (407/1388). 231/1388 (16.7%) procedures were cancelled for the following reasons: 30.5% lack of ITU beds, 20.1% patient medically unfit, 8.2% ITU staff shortage, 6.9% emergency case intervention and 34.2% other. There was no significant difference in mortality between groups (2.6% in C versus 1.6% in NC, p=0.62). In group C, 36% (84/231) of patients underwent surgery within 72 hours of cancellation, 47% (110/231) of procedures were rescheduled, and 6.9% (16/231) were not performed. 30.7% (71/231) were potentially preventable. All cancelled patients were asked to complete the survey; 43.7% (101/231) responded, with 22.8% (23/101) describing feeling upset. However, 92.1% (93/101) felt the cancellation was justified.Conclusions: This single institutional study suggests a relatively high number of planned same-day surgeries are being cancelled. A third of these may be preventable. Despite this, patients were understanding. Actions to decrease cancellations should be identified to improve efficiency.

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.

Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease.

To determine the prevalence and predictors of nonattendance in an ACHD outpatient clinic, and to examine the relationship between nonattendance and emergency department (ED) visits, hospitalizations, and death. Patients≥18 years who had scheduled appointments at an ACHD outpatient clinic between August 1, 2014 and December 31, 2014 were included. The primary outcome of interest was nonattendance of the first scheduled appointment of the study period, defined as "no-show" or "same-day cancellation." Secondary outcomes of interest were ED visits, hospitalizations, and death until December 2017. Of 527 scheduled visits, 55 (10.4%) were nonattended. Demographic and socioeconomic characteristics such as race, income, and insurance type were associated with non-attendance (all P values<.05), whereas age, gender, and disease complexity were not. On multivariable analysis, predictors of nonattendance were black race (adjusted odds ratio [AOR] 4.95; P<.001), other race (AOR 3.54; P=.003), and history of no-show in the past (AOR 4.95; P<.001). Compared to patients who attended clinic, patients with a nonattended visit had a threefold increased odds of multiple ED visits and a significantly lower rate of ED-free survival over time. There were no significant differences in hospitalizations or death by attendance. ACHD clinic nonattendance is associated with race and prior history of no-show, and may serve as a marker of higher ED utilization for patients with ACHD.

Same-Day Cancellation in Ambulatory Surgery: A Retrospective Review at a Large Academic Tertiary Referral Center.

Although ambulatory surgery offers patients convenience and reduced costs, same-day cancellation of ambulatory surgery negatively affects patient experiences and operational efficiency. We conducted a retrospective analysis to determine the frequency and reasons for same-day cancellations in an outpatient surgery center at a large academic tertiary referral center. Of 41 389 ambulatory surgical procedures performed, same-day cancellations occurred at a rate of 0.5% and were usually unforeseeable in nature. Focusing on foreseeable cancellations offers opportunities for enhanced patient satisfaction, improved quality of care, and systems-based practice improvements to mitigate cancellations related to areas such as scheduling or patient noncompliance.

The association between interval from acceptance to first-time donation, missed first appointment and future donation behaviour.

We examined the association of the interval between the date an individual is accepted for blood donation and the date of first donation (IFD-interval, index-to-first-time donation interval) and missed first appointment with future donation behaviour among new donors. These two variables have not been analysed in previous studies of donation behaviour among new donors. Categories were generated for age (18-29 vs 30-65 years), missed-appointment status (no-show vs same-day cancellation) and the IFD-interval [short (≤median time) vs long (>median time)]. Accepted donors (n = 807) were followed for 19 months. Outcome measures were first-appointment attendance rates, return rates among first-time donors and the proportion of experienced donors, defined as those who gave ≥5 donations. In logistic regression analyses, high no-show rates were significantly associated with decreased likelihood of first-time donation. Long IFD-intervals were significantly associated with decreased likelihood of returning for a second donation among first-time donors. Experienced donors, compared to novice donors, were more likely to be male than female, older than younger and with shorter vs longer IFD-intervals. No-show and long IFD-intervals may be behavioural markers of low levels of motivation for making the first donation and for returning for a second donation, respectively.

Predictors of Nonattendance at an Endocrinology Outpatient Clinic

To identify predictors potentially contributing to patients' nonattendance or to same-day cancellation of scheduled appointments at an adult endocrinology office practice. A retrospective, records-based, cross-sectional study was conducted using data from 9,305 electronic medical records of patients presenting at a U.S. metropolitan adult endocrinology clinic in 2013. Statistical analyses included multivariate regression, calculated odds ratios, and posttest probabilities. Of 29,178 total patient visits analyzed, 68% were attended by patients. Of total scheduled appointments, 7% resulted in nonattendance and 5% in same-day cancellation. The most significant predictors of nonatten-dance were a previous history of nonattendance (P<.001), uncontrolled diabetes (P<.001), and new patients to the practice (P<.001). Long lead-time to appointment (P = .001), younger age (P<.001), and certain insurance carriers (P<.001) also were significant predictors. Specific predictors of nonattendance at scheduled appointments were identified using statistical analysis of electronic medical record data. Previous history of nonattendance and having uncontrolled diabetes (especially in patients newly referred to the practice) are among these significant predictors. Identifying specific predictors for nonattendance enables targeted strategies to be developed. APRN = Advanced Practice Registered Nurse CI = confidence interval DM = diabetes mellitus EMR = electronic medical record HbA1c = glycated hemoglobin NS = no-show OR = odds ratio SDC = same-day cancellation.

The socioeconomic impact of patient no-shows and same-day cancellations on a university-based pediatric ophthalmology practice

Patient no-show and same-day cancellation frequencies are an ongoing problem for many pediatric ophthalmology practices. This study places a dollar value on the economic losses that result from clinic vacancies in a university based practice due to a patient not presenting for a scheduled appointment, or cancelling the day of the appointment.

Avoiding Same-Day Cystoscopy Cancellations by Veterans: Nurse-Led Education Improved Efficiency for Cystoscopy in VA Urology Clinics

Same-day cancellation of outpatient cystoscopy was recognized as a growing problem in a New Mexico Veterans Administration regional urology clinic. A multidisciplinary team initiated a performance improvement project using the VA-TAMMCS method to address the problem. The resulting changes in patient education significantly reduced cystoscopy cancellations and improved overall patient satisfaction.

Factors impacting same-day cancellation of outpatient pediatric magnetic resonance imaging under anesthesia.

Studies of elective surgical procedures indicate that cancellation is common and preventable. Little is known about cancellation of anesthesia-supported elective diagnostic imaging. To describe the reasons for same-day cancellation of MRI studies performed under sedation or anesthesia and identify patient characteristics associated with cancellations. This case-control study was carried out in a university-affiliated tertiary care children's hospital. Cases were defined as elective outpatient MRI studies booked under anesthesia that were cancelled after the patient had arrived in the radiology department in 2009. Matched controls were identified by selecting the same day and time 1 week before or after the cancelled case. Main outcome measures included demographics, MRI study characteristics, and social and medical factors. There were 111 outpatient anesthesia-supported MRI studies cancelled on the same day as the assessment (cancellation rate: 4.5%), of which 74.6% were related to family and patient factors, while 22% were related to system factors. Cancelled cases involved patients who lived in lower median income quintile neighborhoods compared to controls (2 vs. 3; P = 0.0007; odds ratio [OR] 3.81; 95% confidence interval [CI] 1.18-12.34). Those who traveled a greater median distance (in kilometers) were less likely to be cancelled (18.8 vs. 27.1, P = 0.0035). Although cancelled patients had a lower mean number of total medical services (2.5 vs. 3.0; P = 0.03; OR = 0.78; 95% CI 0.62-0.98), current medical factors (past 12 months) did not impact cancellations. Same-day cancellations of anesthesia-supported MRI studies are not uncommon, and the main predictor of cancellation seems to be socioeconomic rather than medical.