Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country

Abstract

Data on all patients scheduled to have elective and emergency surgeries during the period of 6 weeks from September 1999 to October 1999 were prospectively collected to determine scheduled starting times, actual starting times, completion times, causes for delays and cancellations. Of 840 procedures scheduled during the study period, 594 (71%) were available for analysis. Eighty-nine per cent of cancellations occurred in patients undergoing elective surgery. The common causes of cancellations were non-availability of beds in recovery room (RR) (15%), patients not showing up (9%), improper pre-operative patient preparation (13%), unavailability of nurses (11%) and anaesthetists (8%). Twenty-three per cent of the cancellations were day cases. Public patients were cancelled more frequently than private patients. Surgical procedures started on time in only 7% of patients. The most common cause of delay was due to delayed transport of patients to the operating theatre (17%). Optimal utilisation of operating theatres in our situation may be effected by increasing the bed-strength of ICUs to free the RR, proper pre-operative work up, adequate counselling of day-care surgery patients and efficient floor management of the operating theatre.

Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences

“…In addition delay may caused by several factors in the hospital prior to emergency laparotomy. Factors often listed are; patients' factors and institutional inadequacies 8,9 . These delays contribute to further physiological deterioration of the sick, which is inimical to a satisfactory post-surgical outcome .…”

A Theatre Time Utilization Survey in a University Teaching Hospital from a Developing Country

“…Many of these delays were avoidable and could have been minimized by a more effective utilization of OR time and schedule. Previous studies suggested that there is a high incidence of delay in the start time of the first case on the list with some studies reporting incidence of delays above 90% [6,7]. Our data showed that the situation is worse in our hospital; with none of the first-on-the-list procedures starting on time.…”

“…The TUC should be empowered not only to identify bottlenecks in theatre efficiency, but to enforce adherence to laid down procedures, and to discipline erring personnel. Every hospital is unique in terms of its service, staffing, demographics of the region, work-ethics and culture [6]. Considerable operating theatre time is wasted while patients are transferred to the operating theatre in our hospital.…”

Delay in Surgical Management of Orthopedic Trauma Patients in an Urban Tertiary Care Hospital of India: A Crossectional Study

“…Theatre inefficiency has been shown to be a major factor in the delay encountered in treating surgical patients especially in the developing countries. [12] In such circumstances, the solution lies in the improvement of efficiency of the operating theatre, alternatively, theatre time needs to be increased in order to accommodate all trauma and elective admissions in reasonable time. This buttresses the wisdom in the proposal by Villa and coworkers that the allocation of beds and operating theatre hours should be based on patient flow characteristics of the various units and specialties in the hospital.…”