The impact of a structured preoperative protocol on day of surgery cancellations

Abstract

Aims and objectives:To evaluate the impact of implementing an evidence-based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties.Background: Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care.Design: Observational study with two study phases: before and after.Methods: The cancellation data were collected from the hospital register from 1September 2013-31 May 2014 (n = 591) and from September 2015-May 2016(n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically.Results: Cancellation rates varied between 1.6%-9.7% (in the first phase) and between 1.5%-7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found.Conclusions: A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates.Relevance to clinical practice: An evidence-based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high-quality care for surgical patients. | INTRODUCTIONCancellations are a problem in perioperative care, and most of them are preventable (Kumar & Gandhi, 2012). It has been estimated that 50%-65% of cancellations could be potentially avoided (Chughtai, Michael, & Qurashi, 2014;Fitzsimons, Dilley, Moser, & Walker, 2016;Kim & Lee, 2014). In this study, day of surgery cancellation (DOS) is defined as a scheduled elective operative procedure that was cancelled on the same day it was planned to occur. DOS cancellations are described to be one of the 23 nursing-sensitive quality indicators for evaluating and monitoring efficiency, patient safety and crisis event management in perioperative care (Wu et al., 2017 The largest costs of cancelled surgeries after the preparation of the surgery room and during the surgery itself are related to human resources (62.8%) (Perroca, Jerico Mde, & Facundin, 2007).In tertiary care paediatric outpatient surgical centres, the cost of a cancelled urology patient was 4,802 US dollars, which led to an approximately 500,000 dollar loss over a 7-month period with a cancellation rate of 13.3% (Pohlman, Staulcup, Masterson, & Vemulakonda, 2012). Calculating the actual overall cost of cancellations is complicated because of the variations in care ...

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“…The late cancellation rate in this study of 4·3 per cent is similar to that reported previously from the authors' hospital, which was 4·6–4·7 per cent in 2013–2016 for different types of elective surgical operation. These rates are slightly lower than those reported in earlier publications, where cancellation rates varied between 6 and 15 per cent.…”

Financial cost of elective day of surgery cancellations

“…The aim of this study was to measure the financial cost of DOS cancellations in a university hospital's 13 operative specialties after the hospital implemented an evidence based structured preoperative protocol. [9,31] According to the results, DOS cancellations caused a financial loss of nearly a million euros during the nine-month study period. To the best of our knowledge, this is the first academic study to measure the financial costs of surgery cancellations in Finland, and it supports previous estimates of the financial costs of elective surgery cancellations.…”

“…The data were linked with DOS cancellation rates and reasons col-lected from an administrative database for surgical patients for the period from September 1, 2015 to May 31, 2016. [9] Costs of cancellations are reported in euros in terms of total waste and savings.…”

“…[6] Cancellation occurrences vary widely across health care organizations; the highest rate may be more than 700 times higher than the lowest. [7] Studies published since 2016 report variable elective DOS cancellation rates of 4.4% (tertiary care teaching hospital in Lebanon), [8] 4.7% (university hospital in Finland), [9] 8.8% (pediatric ambulatory surgery center in the US), [10] 26% (regional hospital in Oman), [11] and 44.5% (general hospital in South Africa). [12] Similar to cancellation rates, costs of surgical procedures vary across countries and are related to the type of procedure.…”

“…Data are drawn from a university hospital's 13 operative specialties after the implementation of an evidence based, structured preoperative protocol. [9,31] Literature review A literature review of costs of DOS cancellations was conducted in PubMed and CINAHL in 2010-2017 using keywords such as "surgery", "operation", "cancellation", "cost", and "evaluation". Articles included in the literature review are presented in Table 1.…”