BACKGROUND AND OBJECTIVES: Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation.METHODS: Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and textmessage reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. RESULTS:Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites.CONCLUSIONS: By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization.Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time but is frequent in children's hospitals. 1 Families suffer inconvenience, emotional distress, and financial cost. 2 Reducing DoSC therefore improves OR utilization and also reduces impact on families. Likewise, rescheduling in advance, where appropriate, facilitates reshuffling of the operative list and accommodation of add-on cases and minimizes disruption to family life. Among the dimensions of health care quality enumerated by the Institute of Medicine, family-centeredness, efficiency, and timeliness are all impacted. 3

The surgical consent serves as a key link in preventing breakdowns in communication that could lead to wrong-patient, wrong-site, or wrong-procedure events. We conducted a quality improvement initiative at a large, urban pediatric academic medical center to reliably increase the percentage of informed consents for surgical and medical procedures with accurate safety data information at the first point of perioperative contact. Improvement activities focused on awareness, education, standardization, real-time feedback and failure identification, and transparency. A total of 54,082 consent forms from 13 surgical divisions were reviewed between May 18, 2011, and November 30, 2012. Between May 2011 and June 2012, the percentage of consents without safety errors increased from a median of 95.4% to 99.7%. Since July 2012, the median has decreased slightly but has remained stable at 99.4%. Our results suggest that effective safety checks allow discovery and prevention of errors.

A procurement program is described which is designed to provide blood from volunteer donors for about 10,000 transfusions (10,000 pints) a year. The program consists of: (1) pre‐admission deposit of blood in the hospital banks by relatives and friends of patients; (2) efficient exchange of blood among the seven participating hospitals; (3) formation of blood‐assurance groups in the community. During its six years of operation, the program has almost completely eliminated the purchasing of commercial blood; it has reduced by half, out‐dating of blood in the banks; and it has doubled the amount of blood supplied by the assurance groups.

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