Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement
ABSTRACT This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system.
CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities.
Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive.
Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.
- SourceAvailable from: Rebecca M Speck
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- "This clinical dilemma often leads to same day surgical case cancellations resulting in delay and/or denial of the surgical care needed for these veterans. Same day case cancellation also results in wasting of the operating room (OR) resources and of valuable health care dollars . Currently, there are no published guidelines to support the clinical decision making regarding perioperative management of patients with history of cocaine abuse . Clinical practices vary widely based on individual anecdotes and personal experience. "
ABSTRACT: Background. Perioperative management of cocaine-abusing patients scheduled for elective surgery varies widely based on individual anecdotes and personal experience. Methods. Chiefs of the anesthesia departments in the Veterans Affairs (VA) health system were surveyed to estimate how often they encounter surgical patients with cocaine use. Respondents were asked about their screening criteria, timing of screening, action resulting from positive screening, and if they have a formal policy for management of these patients. Interest in the development of VA guidelines for the perioperative management of patients with a history of cocaine use was also queried. Results. 172 VA anesthesia departments' chiefs were surveyed. Response rate was 62%. Over half of the facilities see cocaine-abusing patients at least once a week (52%). Two thirds of respondents canceled or delayed patients with a positive screen regardless of clinical symptoms. Only eleven facilities (10.6%) have a formal policy. The majority of facilities (80%) thought that having formal guidelines for perioperative management of cocaine-abusing patients would be helpful to some extent. Results. 172 VA anesthesia departments' chiefs were surveyed. Response rate was 62%. Over half of the facilities see cocaine-abusing patients at least once a week (52%). Two thirds of respondents canceled or delayed patients with a positive screen regardless of clinical symptoms. Only eleven facilities (10.6%) have a formal policy. The majority of facilities (80%) thought that having formal guidelines for perioperative management of cocaine-abusing patients would be helpful to some extent. Conclusions. There is a general consensus that formal guidelines would be helpful. Further studies are needed to help formulate evidence-based guidelines for managing patients screening positive for cocaine prior to elective surgery.Anesthesiology Research and Practice 08/2013; 2013:149892. DOI:10.1155/2013/149892
Article: Ablauforganisation[Show abstract] [Hide abstract]
ABSTRACT: Am besten geeignet für den Einstieg in die Organisationsveränderung sind die Geschäftsprozesse und die mit ihnen verbundene Ablauforganisation. Aufbauend auf der Vision und den strategischen Zielen stellt sich die Frage: Welche Ergebnisse wollen wir in welchen Bereichen erzielen? In welcher Weise tragen sie zur Erreichung der Vision und der strategischen Ziele bei? Welche Rolle nehmen diese Ergebnisse in Bezug auf die Gesamtorganisation ein, und welche Werte des Unternehmens werden dadurch besonders unterstützt?