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Financial cost of elective day of surgery cancellations

Authors:
  • Diaconia University of Applied Sciences, Finland

Abstract

Operative care is one of the major areas of healthcare services as over 310 million surgeries are conducted yearly. Surgery cancellations is a widely used indicator when evaluating the quality of preoperative care. Cancellations cause financial lost for organizations, however there is only limited research about the costs. The aim of this study was to evaluate the cost of elective day of surgery (DOS) cancellations in 13 operative specialties at a university hospital in Finland between September 1, 2015 and May 31, 2016 after a structured preoperative protocol was implemented to practice and a cancellation rate of 4.7% was recognized. Procedure prices conducted the data for the research and were collected from the hospital’s invoicing system. Financial loss and savings of cancellations were calculated from the total cost of procedures. As a result the total cost of DOS cancellations during the nine-month time period was 953,374.27 euros and mean loss of a single cancelled operation was 2,459.91 euros. The total of material savings for the hospital were 106,917.33 euros. As a conclusion, DOS cancellations cause unnecessary wastage, and financial aspects should be followed and evaluated systematically by setting goals and providing continuing developments.
jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
ORIGINAL ARTICLE
Financial cost of elective day of surgery cancellations
Elina Turunen1,2, Merja Miettinen3, Leena Setälä4, Katri Vehviläinen-Julkunen2,3
1Diaconia University of Applied Sciences, Finland
2Department of Nursing Science, University of Eastern Finland, Finland
3Kuopio University Hospital, Finland
4Hospital District of Southwest Finland, Finland
Received: June 16, 2018 Accepted: November 13, 2018 Online Published: November 19, 2018
DOI: 10.5430/jha.v7n6p30 URL: https://doi.org/10.5430/jha.v7n6p30
ABS TR ACT
Operative care is one of the major areas of healthcare services as over 310 million surgeries are conducted yearly. Surgery
cancellations is a widely used indicator when evaluating the quality of preoperative care. Cancellations cause financial lost for
organizations, however there is only limited research about the costs. The aim of this study was to evaluate the cost of elective day
of surgery (DOS) cancellations in 13 operative specialties at a university hospital in Finland between September 1, 2015 and May
31, 2016 after a structured preoperative protocol was implemented to practice and a cancellation rate of 4.7% was recognized.
Procedure prices conducted the data for the research and were collected from the hospital’s invoicing system. Financial loss and
savings of cancellations were calculated from the total cost of procedures. As a result the total cost of DOS cancellations during
the nine-month time period was 953,374.27 euros and mean loss of a single cancelled operation was 2,459.91 euros. The total of
material savings for the hospital were 106,917.33 euros. As a conclusion, DOS cancellations cause unnecessary wastage, and
financial aspects should be followed and evaluated systematically by setting goals and providing continuing developments.
Key Words: Economics, Finance, Waste, Cost, Surgery cancellation, Operative care
1. INTRODUCTION
The hospital sector is the largest component of health care
spending in the Organization for Economic Co-operation
and Development (OECD) and European Union (EU) coun-
tries.
[1]
Surgery is one of the major areas of healthcare ser-
vices. Globally, approximately 312.9 million operations are
conducted every year.
[2]
According to study results of a
cross-sectional and longitudinal study conducted in USA the
mean cost of one minute of operation room (OR) time is
approximately 36-37 US dollars.
[3]
Day of surgery (DOS)
cancellations are a recognized problem in perioperative care
and one of the nursing-sensitive quality indicators in peri-
operative care.
[4]
A single cancellation causes personal and
economic harm for the patient
[5]
and resource related waste
for organizations.[6]
Cancellation occurrences vary widely across health care orga-
nizations; the highest rate may be more than 700 times higher
than the lowest.
[7]
Studies published since 2016 report vari-
able 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.[7, 13, 14]
The development of surgical processes is encouraged as a
Correspondence:
Elina Turunen; Email: elturunen@gmail.com; Address: Department of Nursing Science, University of Eastern Finland,
Yliopistonranta 1, P.O. Box 1627, FI-70211 Kuopio, Finland.
30 ISSN 1927-6990 E-ISSN 1927-7008
jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
way to reduce unnecessary costs.
[1]
Practices for enhancing
high-quality, safe and cost-effective perioperative processes
have been implemented worldwide in recent years. Preop-
erative cost effectiveness requires optimization of the surgi-
cal process and patient specific management.
[15]
A patient-
centered approach to the reform of preoperative care has
led to positive change, decreasing DOS cancellations and
average length of stay and increasing patient volume, OR
use, the number of patients admitted on the DOS, and patient
satisfaction.[9, 16–23, 23–28, 28]
“Cost” is defined as the amount of hospital expenditures for
resources used to deliver care.
[13]
Operational costs in the
OR depend on start times, turnover times, cancellation rates,
supplies, equipment, and staffing.
[30]
The development and
remodeling of surgical processes to achieve cost effective-
ness have been encouraged. Researchers have been careful in
measuring the economic impact of these changes, although
evaluation based on cost is recommended.[16,26]
The aim of this study is to measure the financial cost of DOS
cancellations. 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 con-
ducted in PubMed and CINAHL in 2010-2017 using key-
words such as “surgery”, “operation”, “cancellation”, “cost”,
and “evaluation”. Articles included in the literature review
are presented in Table 1. A total of six academic journal
articles reported on costs of cancellations. Four articles were
published in the United States,
[32–35]
one in Brazil,
[36]
and
one in South Africa.
[12]
In addition, an editorial article pub-
lished in the United States discussed OR time costs and sug-
gested using an average cost of 15 to 20 US dollars per OR
minute for a basic surgical procedure, excluding physician
costs.[13]
The earliest cost evaluation was based on data collected in
2004,
[36]
and the latest used data from 2014.
[12, 35]
Calcula-
tions of surgery cancellation costs were based on several dif-
ferent indicators: wasted OR time,
[32, 33]
hospital and physi-
cian data, such as the average surgeon fee for the planned
procedure, including the average hospital facility fee per
minute based on planned surgical time,
[34]
an organization’s
annual statistics on what were considered unnecessary in-
patient days,
[12]
and nurse-led preoperative assessments.
[35]
Costs of cancellations were measured after preparation of
the operating room and during the operation, costs were di-
vided into four parts: materials, fees, medication, and human
resources.[36]
The average cost of a cancelled operation in the US is approx-
imately 5,000 to 8,000 US dollars.
[33–35]
In South Africa, the
cost is approximately 2,000 US dollars,
[12]
and in Brazil, it is
30 US dollars.
[36]
Wasted OR suite minutes cost 10 to 20 US
dollars per minute on average in the US.
[13, 32]
Research on
the financial cost of DOS cancellations is limited, and more
evidence-based studies are needed to promote understanding
of the costs of cancelled operations.
2. METHODS
2.1 Aims
The aim of this study is to measure the financial cost of DOS
cancellations using procedure prices for a university hospi-
tal’s 13 operative specialties during a nine-month period.
2.2 Research site
The research was conducted at a university teaching hospi-
tal in Finland. The hospital is responsible for specialized
medical care for nearly a million inhabitants and provides
care in all surgical specialties. The hospital has 26 oper-
ating theaters where approximately 22,000 procedures are
conducted yearly. OR staff work in elective surgery setting
mainly Monday to Friday between 7:00 a.m.–3:30 p.m.
The hospital put a structured, evidence based preoperative
protocol into clinical practice in all 13 operative special-
ties (gastrointestinal surgery; pediatrics; hand surgery; car-
diac and thoracic surgery; urology; vascular surgery; neuro-
surgery; gynecology; ophthalmology; ear, nose, and throat
surgery; dental surgery; orthopedics; and plastic surgery)
between the years 2014 and 2015. In May 2015, all intra-
operative care and recovery areas were gathered and moved
to a single location while a new hospital building was being
opened.
The new protocol was coordinated by preoperative nurses.
Their main responsibility was to meet patients’ needs individ-
ually, prepare patients for surgery, and cooperate with other
professionals in the patients’ care.
[31]
The implementation
of the new preoperative protocol led to an increase in the
number of patients arriving at the hospital on the day of an
operation and decreased the DOS cancellation rate signifi-
cantly in cases where the “patient did not show up”. The
total DOS cancellation rate at the hospital was 4.7%.[9]
2.3 Ethical approval
The University Committee on Research Ethics evaluated the
ethical aspects of this research and stated that the research
was scientifically justified (25/2014). The university hospital
granted permission to conduct the research (1/2015).
Published by Sciedu Press 31
jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
2.4 Data collection and analysis
This was a retrospective cross-sectional cost evaluation study.
Data were collected from the hospital’s invoicing system
with the hospital account manager’s assistance. 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.
Table 1. Research reporting costs of surgery cancellations (years 2007-2017)
Source
Research site
Cost indicator and data
collection
Outcomes
Cost of a cancellation
per patient
Fitzsimons
et al., 2016.
USA
General hospital
Cardiac patients
Wasted OR time
Jan 2010 Dec 2013
5110 scheduled cases, 43 cancellations (0.84%).
The cancellations resulted in 89 hours and 34 minutes of wasted
OR time.
The most commonly referenced average cost of unstaffed OR
time is 62 US dollars/minute.
This value would add 333 188 US dollars to the costs of the
cancellations.
333,188/43 =
7,748.60 US dollars
Sebach
et al., 2015.
USA
An evidence-based
NP-managed
preoperative
evaluation clinic
Nurse-led preoperative
assessment
October to December 2013
and October to December
2014
Pre: 2,789 completed surgeries and 77 cancellations.
Post: 2,372 planned surgeries and 36 cancellations.
The lost revenue from 77 surgical cancellations was $386,033.
The lost revenue from 36 surgical cancellations was $184,480.
(386,033 + 184,480)/
(77 + 36) =
5,048.80 US dollars
Argo
et al., 2009.
USA
123 Veterans Health
Administration
medical centers
9 specialties
Wasted OR time
per year 2006
329,784 scheduled surgeries, 40,988 cancellations (12.4%).
The cost of unused OR time in the VA has been estimated at $600
per hour in 2009 dollars (total OR cost divided by work hours
minus material costs).
Cancellations of elective surgical cases are inefficient and costly
to the VA system, with a 1.4% CR leading to an estimated loss of
more than 32 million US dollars in 2006.
10 US dollars/OR suite
minute
Pohlman
et al., 2012.
USA
Outpatient surgery
center, 318-bed
tertiary care pediatric
hospital
Urology
Results were calculated from
hospital and physician data
as the average surgeon fee for
the planned surgical
procedure plus the average
hospital facility fee per
minute based on planned
surgical time
January to July 2010
114 cancellations out of 854 scheduled procedures during the
study period.
The potential lost revenue for cancelled outpatient pediatric
urology procedures averaged $4,802 per cancellation, with an
estimated $500,000 in lost revenue during the 7-month study
period.
4,802 US dollars
Bhuiyan
et al., 2017.
South Africa
One main operation
theatre
The cost of inpatient stay
January to December 2014
537 booked patients and 239 cancellations (44.5%).
The cost per inpatient per day was estimated at ZAR 4,890 at PTB
Hospital and ZAR 2,100 at district hospitals, and the total cost per
cancelled operation was ZAR 25,860.
The cost incurred due to cancellations was approximately ZAR 6
million for the hospital, with additional cost and emotional trauma
for the patients.
ZAR 25,860 =
1,894.56 US dollars
(13.4.2017 exchange
rate)
Perroca
et al., 2007.
Brazil
Surgical center of a
public teaching
hospital
1,600 large-,
medium- and
small-size
surgeries/mo
Cancellations after the
preparation of the surgery
room and during the surgery
(materials, fees, medication
and human resources)
Three consecutive months in
2004
58 (23.3%) of the 249 cancelled scheduled surgeries represented
costs for the institution.
The cancellations’ direct total cost was R$1,713.66 (average cost
per patient R$29.54).
Materials R$333.05
Sterilization process R$201.22
Medications R$149.77
Human resources R$1,029.62
Human resources costs represented the greatest percentage in
relation to total cost (60.40%).
Average cost per patient
R$ 29.54
29.54 US dollars
(18.4.2017 exchange
rate)
Macario,
2010.
USA
Editorial comment
about costs of
operating room time
“Excluding physician costs, OR administrators may use a ballpark
number such as $15 to $20 per OR minute for a basic surgical
procedure.”
15-20 US dollars/OR
minute
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jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
Procedure prices
Mean cost prices of operative procedures were collected from
the hospital’s invoicing system for the year 2016 in euros.
The price of a procedure is calculated as mean costs of simi-
lar procedures during one year. There is no profit in the price
as the hospital works as a non-profit institution. The price of
a single operation consists of anesthesia resources, recovery
room, implants, surgeon, medicine, environment (OR + OR
staff), special equipment (e.g., a surgery robot) and specialty
specific equipment. The cost of a cancellation was defined
as resources that were reserved for the scheduled surgery for
a specific patient. The model of calculation was that in case
of a DOS cancellation, those resources could not be used for
other purposes. DOS cancellation costs were calculated from
the total cost of a procedure as follows:
DOS cancellation cost = total cost of a procedure – saved
unused products
Saved unused products = implants + medicine + specialty
specific equipment
DOS cancellation cost includes = anesthesia resources
±
recovery room
±
surgeon
±
environment
±
special equip-
ment
DOS cancellation costs were reported in 13 operative special-
ties in euros in means, total costs, and by cancellation reason
during the nine-month study period. The invoicing system
did not provide the procedure price in 33 cases. Missing data
were replaced by specialty specific means of savings and
costs.
3. RES ULTS
Total costs of cancellations are presented in Table 2. The to-
tal cost of 542 elective surgery cancellations in 13 operative
specialties was 953,374.27 euros in the nine-month study
period, and the saving of material costs was 106,917.33
euros. The mean loss from a single cancelled operation
was 2,459.91 euros, and the mean saving was 174.47 eu-
ros. The highest mean losses were found in cardiac and tho-
racic (4,539.93
C
) and vascular surgery (3,016.82
C
), and
the lowest were found in ophthalmology (1,026.87
C
) and
urology (1,315.58
C
). However, because of the number of
cancellations in ophthalmology, the total loss was one of the
highest (165,326.50
C
) after orthopedics (212,565.65
C
) and
neurosurgery (165,416.39
C
). Mean savings per cancelled
operation were highest in gastrointestinal surgery (409.54
C
),
cardiac and thoracic surgery (399.90
C
), vascular surgery
(338.63
C
), and neurosurgery (313.72
C
). Some specialties
did not achieve any savings, or savings were minor; these
included dental surgery (0.19
C
), plastic surgery (10.78
C
),
and pediatrics (18.36 C).
Table 2. Costs and savings of DOS cancellations (n = 542) by operative specialties, September 1, 2015-May 31, 2016
Medical specialty
Missing data
Cost per
cancellation
Cost per
cancellation, range
Saving per
cancellation
Saving per
cancellation,
range
Total cost of
cancellations
Total saving of
cancellations
(n)
(%)
(mean €)
(€)
(mean €)
(€)
(€)
(€)
Gastrointestinal
surgery
2
7.7
1,945.52
799.22 5,738.55
409.54
130.30 1,003.79
46,692.38
9,828.96
Pediatrics
2
11.8
1,510.54
929.52 2,888.52
18.36
0 188.04
25,679.12
312.15
Hand surgery
1
7.1
1,495.49
998.75 2,374.01
113.29
0 636.29
20,936.91
1,586.08
Cardiac & thoracic
3
25
4,539.93
1,532.25 6,679.74
399.90
19.76 861.26
50,890.33
4,821.23
Urology
-
-
1,315.58
822.23 1,724.01
24.42
0 182.93
22,364.90
415.08
Vascular surgery
3
15
3,016.82
1,829.63 5,682.92
338.63
49.48 588.42
60,336.41
6,772.51
Neurosurgery
2
2.7
2,265.98
1,157.88 4,858.70
313.72
0 914.43
165,416.39
22,901.64
Gynecology
7
25
1,519.92
873.04 3,862.10
140.07
0 448.72
42,557.89
3,921.91
Ophthalmology
7
4.3
1,026.87
459.42 2,403.26
188.17
0 920.44
165,326.50
30,296.06
Ear, nose and throat
1
1.4
1,343.10
690.16 5,712.41
74.87
0 460.27
92,673.74
5,165.75
Dental surgery
1
10
2,459.91
626.80 3,064.51
0.19
0 0.28
24,599.11
1.86
Orthopedics
3
3.4
2,415.52
1,206.18 5,363.11
236.21
0 936.22
212,565.65
20,786.30
Plastic surgery
1
10
2,333.49
1,238.27 8,274.29
10.78
0 54.56
23,334.94
107.80
Total Hospital
33
6.1
2,459.91
459.42 8,274.29
174.47
0 1,003.79
953,374.27
106,917.33
Published by Sciedu Press 33
jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
Table 3. Cost of DOS cancellations (n = 542) by reason and operative specialty, September 1, 2015-May 31, 2016
Medical
specialty
Patient did not show up
Resource-related reasons
(no time for operation/rush,
equipment unavailable, a
surgeon unavailable, bed not
available)
Patient unfit for operation
(patient unsuitable for
operation or anesthesia)
No need for operation
Other reasons
(non specific reasons or
administrative mistakes)
Cancellations
Cost
Cancellations
Cost
Cancellations
Cost
Cancellations
Cost
Cancellations
Cost
(n)
(€)
(n)
(€)
(n)
(€)
(n)
(€)
(n)
(€)
Gastrointestinal
surgery
-
0
10
11,849.83
11
31,668.03
2
2,001.66
1
1,172.85
Pediatrics
3
4,398.92
1
1,504.01
8
10,207.53
4
6,695.11
1
2,873.55
Hand surgery
2
3,884.87
-
0
8
11,620.15
4
5,431.90
-
0
Cardiac &
thoracic
-
0
2
8,588.80
7
35,278.25
-
2
7,023.28
Urology
-
0
6
8,659.37
4
4,565.76
4
4,920.33
3
4,219.44
Vascular surgery
-
0
8
20,762.93
7
24,115.60
3
8,489.47
2
6,968.41
Neurosurgery
-
36
79,018.96
17
50,223.27
12
22,291.46
8
13,882.69
Gynecology
1
1,144.26
7
10,316.46
11
17,064.26
6
10,080.27
3
3,952.63
Ophthalmology
9
11,600
41
38,762.45
74
67,681.15
34
46,477.20
3
4,853.22
Ear, nose and
throat
3
3,312.49
12
19,405.58
26
32,368.02
25
33,385.35
3
4,202.31
Dental surgery
1
3,064.51
3
7,621.58
4
8,388.61
-
0
2
5,524.42
Orthopedics
4
10,591.77
48
118,193.52
21
49,808.99
7
173,44.65
8
16,626.72
Plastic surgery
1
8,274.29
1
1,333.77
5
8,423.57
3
5,303.31
-
0
Total Hospital
24
46,271.11
175
326,017.26
203
351,413.19
104
162,420.71
36
71,299.52
Regarding cancellation reasons (see Table 3), the most costly
reason was patients’ unsuitability for the planned operation
(n = 203), causing a total loss of 351,413.19 euros. The
largest shares of this cost were in ophthalmology (67,681.15
C
), neurosurgery (50,223.27
C
) and orthopedics (49,808.99
C
). Resource-related reasons (n = 175) caused the loss of
326,017.26 euros, including the largest losses in orthopedics
(118,193.52
C
) and neurosurgery (79,018.96
C
). In 104
cases, patients were determined not to need the planned oper-
ation, leading to a total loss of 162,420.71 euros for the hospi-
tal; the highest shares in euros were found in ophthalmology
(46,477.20
C
) and ear, nose and throat (33,385.35
C
). During
the study period, there were 24 occasions when the patient
did not show up at the hospital. These cancellations caused
the loss of 46,271.11 euros, and the largest shares were in
ophthalmology (11,600
C
) and orthopedics (10,591.77
C
).
Other unspecified reasons led to a loss of 71,299.52 euros;
the largest shares were in orthopedics (16,626.72
C
) and
neurosurgery (13,882.69 C).
4. DISCUSSION
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 re-
sults, 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.[5,6]
Several factors, such as country and specialty, are recognized
to affect the costs of cancellations.
[13]
The mean cost of a
cancellation was approximately 2,500 euros, which is ap-
proximately half the cost of a cancellation in the US.
[33–35]
By specialty, the cost of a single DOS cancellation was high-
est in cardiac and thoracic and vascular surgery and lowest
in ophthalmology. By reason for cancellation, a major loss
was related to hospital resources and patients’ suitability for
the planned surgery. This finding suggests that a cancellation
rate under 2% may be achieved.
DOS cancellations became less usual among many special-
ties but when total amount of cancellations was calculated in
hospital-level, the result was distorted by the high frequency
of cancellations in ophthalmic surgery. This was due to their
process which was different from other specialties and did
not include a preoperative visit to confirm the need of surgery.
To use their OR resource effectively, they developed a sys-
tem for rapid recruitment of additional patients for each day.
During the study a new reporting system was created to sup-
port each department to further decrease their cancellations.
Unfortunately, our study has no follow-up in this matter.
There are several limitations to this study, and the results are
suggestive. As the data were collected from the hospital’s
invoicing system that is not originally designed for research
34 ISSN 1927-6990 E-ISSN 1927-7008
jha.sciedupress.com Journal of Hospital Administration 2018, Vol. 7, No. 6
purposes. However, the register may be seen as a reliable reg-
ister including high quality data. It provides information that
can be used for study purposes. To strengthen the analysis the
assistance and participation of the hospital account manager
was used. Financial causes of DOS cancellations are calcu-
lated as the mean costs of procedures over a year-long period.
Procedure prices are limited in intraoperative care and do not
include preoperative tests and care or postoperative care and
hospitalization. In some cancellation cases a new patient may
have been operated instead of a cancelled patient, but this
was not considered in this study. Cancellation costs do not in-
clude any compensation paid to patients by the hospital. The
reliability of this study might have been increased by using
supportive data considering OR time used and minute-based
costs,
[13]
as in previous studies.
[32–34]
However, reliable in-
formation about the use of OR time by operative specialty
was not available for research purposes. The financial loss of
DOS cancellations would best be measured in the standard
manner using multiple supportive data sets.
The results of this study may be used to estimate the financial
cost of DOS cancellations to organizations and to compare
financial losses caused by elective surgery cancellations be-
tween different health care providers. Financial costs of DOS
cancellations are a valid outcome measurement when setting
goals and evaluating outcomes in a perioperative setting.
5. CONCLUSIONS
As a conclusion, DOS cancellations cause unnecessary
wastage for health care organizations. Financial aspects
should be followed and evaluated systematically by setting
goals and providing continuing developments for optimizing
health care expenses.
ACKNOWLEDGEMENTS
We would like to acknowledge accounting manager Heini
Koskenvuori, M.Sc. (Econ.), who helped with evaluating the
usefulness of databases and disseminating funds, the North
Savo Hospital District Ministry of Social Affairs and Health,
and Kuopio University Hospital Research Foundation. We
thank the Finnish Foundation for Nursing Education for mak-
ing this research possible through funding.
CON FLI CT S OF INTEREST DISCLOSURE
The authors declare they have no conflicts of interest.
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36 ISSN 1927-6990 E-ISSN 1927-7008
... It is imperative for a well-equipped health institution to have an operation room (OR) which is closely monitored and maintained by the institution's administrator in collaboration with the government. The ORs have been recognized as one of the most vital healthcare services as over 310 million surgeries are conducted worldwide every year (Turunen et al., 2018). Surgical procedures heavily contribute to an institution's income as patient pay for their surgical service. ...
... Therefore, cancellation of surgery may harm patients, influence their quality of life, and increase stress for the patient, families, and staff. Turunen et al. (2018) confirm that there is a significant correlation between the elective day of surgery cancellation and adverse psychological concerns. Most of perioperative patients become anxious time and continuously need their nurses to be close to provide emotional support and guidance for them. ...
... This QI initiative is also particularly important for improving the utilization of OR resources, time, and cost. This is due to the fact that the OR has a major part of the hospital budget (Turunen et al., 2018). Another project outcome includes reducing unnecessary costly preoperative diagnostic testing, referrals, hospital stays, which ultimately will ease the pressure on the available resources (Sau-Man Conny and Wan-Yim, 2016). ...
... Second, it may result in unnecessary hospital admission [6]. Such a situation causes a non-essential consumption of medical resources, and at the same time brings a huge burden to healthcare services, while the corresponding patients will also pay for it [8][9][10][11][12]. In addition, cancellation of surgery may impair the physical and psychological health of the patient. ...
... Our nding from a tertiary teaching hospital showed that a high cancellation rate in China, and approximately 1 in 19 patients (5.4%) who were scheduled for primary THA or TKA ended up having their surgeries cancelled. What matters is that each cancellation creates additional work for the medical team, adds to the unnecessary consumption of medical resources, impairs the patient's physical and psychological health, and can potentially worsen the patient's outcome [7][8][9][10][11][12][13][14][15][16][17]. Our study manifested that cancellations will result in signi cant additional costs (4139 RMB per person) for patients and increased non-surgical hospital stays (4 days per person). ...
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Background The aim of the present study is to analyze the hospital length of stay (LOS), total hospital expense (THE), reasons, and subsequent fate of patients who had a total joint arthroplasty (TJA) cancelled. Methods In December 2020, we retrospectively reviewed a consecutive series of 18,508 patients who underwent primary total hip arthroplasty or knee arthroplasty between January 2009 and December 2018. Patients with unexpected cancellations of scheduled TJA surgeries were identified. LOS, THE, reasons for cancellations, and the number of patients who eventually performed arthroplasty were recorded. Results A total of 1,003 (5.4%) participants had scheduled TJA surgeries cancelled, which included 23 (2.3%) with two cancellations and 980 (97.7%) with one cancellation. The median LOS and THE of cancellations were 4 days (interquartile range [IQR] 3–7) and 4139 RMB (IQR 2611-6583.5), respectively. There were 720 patients (71.8%) who were cancelled due to medical-related reasons. Compared to non-medically related cancellation, medical-related cancellation had a higher age (60.9 vs 54.2, p < 0.001), LOS (5 vs 3, p < 0.001), and THE (4862 vs 2661, p < 0.001); meanwhile, the latter had a higher percentage of two cancellations (3.2% vs 0.0%, p = 0.002). During the follow-up, three hundred and twenty-three (32.3%) patients finally performed joint replacement in our institution, and the median time interval between the originally scheduled date of surgery and the actual date of surgery was 94 days (IQR 46-275.5). Conclusions This study suggests that the cancellation rate is relatively high in TJA practice, and medical-related cancellations are the most common. On the other hand, cancelling the operation will result in huge additional costs for patients and increased length of non-surgical hospital stay. Given that many of the reasons for cancellation are modifiable, a physician-guided pre-admission assessment is necessary to erase the concerns before the patient is admitted. Meanwhile, to prevent further delays, attention should be paid to patients whose TJA procedures have been cancelled and help them get their procedures rescheduled in a timely manner.
... The poor use of resources leads to increased waiting times as well as considerable added costs. The mean cost of 1 minute of operating theatre time has been estimated to be approximately 37 US dollars in the USA, and a Finnish study estimated that a single cancelled operation resulted in a loss of almost 2500 euros [13,14]. ...
... This may require the recruitment of additional staff, and consequently a cost to our department. However, given the cost of cancellations estimated by Turunen and colleagues, we anticipate that the cost of additional human resources will be offset by the savings obtained with reduced cancellations [13]. ...
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Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of ‘lead-in’ antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%–16%) patients were started on antibiotics each month, while another zero to two (0%–2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.
... Nevertheless, it is still often the case that each parent receives the same routine information about their child's procedure, with this information expected to meet everyone's needs and expectations (Lööf & Lönnqvist, 2022). The prevalence of the routine approach is surprising, as taking individual needs into account strengthens the parent's ability to cope (Eldridge & Kennedy, 2010;Lerret, 2009) and reduces cancellations of procedures (Turunen et al., 2018). ...
... Nevertheless, it is still often the case that each parent receives the same routine information about their child's procedure, with this information expected to meet everyone's needs and expectations (Lööf & Lönnqvist, 2022). The prevalence of the routine approach is surprising, as taking individual needs into account strengthens the parent's ability to cope (Eldridge & Kennedy, 2010;Lerret, 2009) and reduces cancellations of procedures (Turunen et al., 2018). ...
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Aim The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint. Design Empirical Research Mixed Method. Methods The research applied a mixed‐methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2–6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi‐structured interviews were conducted with 15 parents to better understand their experiences. Results According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.
... Canceling and delaying surgeries put a huge burden on healthcare providers, including hospitals, physicians, medical assistants, and nursing staff [1], and it has financial, psychological, and social consequences for patients and their families [2][3][4]. In the United States (US), the value of each wasted minute of operating room time was estimated to be between $10 -$20, and the average canceled operation costs $ 5,000-8,000 [5]. Only one single-center study in Iran has reported the average cost of surgery cancellations to be around US$ 92,049.0 ...
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Introduction Canceling scheduled surgeries on the day of surgery places a heavy burden on healthcare providers and has psychological, social, and financial consequences on patients and their families. This study aimed to investigate the main reasons for cancellations of elective procedures and provide appropriate recommendations to reduce the rate of such avoidable cancellations. Methods Data were collected retrospectively from all consecutive elective cases scheduled for various elective surgeries from January 1, 2020 to March 31, 2022 at Namazi Teaching Hospital, a major referral center in southern Iran with a capacity of 938 beds. Daily data were collected on the number of planned electives, cancellations, and reasons for cancellations. Surgical cancellation reasons were categorized as patient-related, surgeon-related, hospital/system-related, and anesthesia-related. Data were expressed as frequency (percentage) and analyzed with SPSS version 19 software. Results The cancellation rate on surgery day for elective procedures in all fields was 6.3%. The highest cancellation rate was related to minor surgeries (19%), followed by urology (8%), pediatrics (7%), and plastic surgery (7%). The most common reasons for cancellation were patients not suitable for the procedure (37%), followed by patients who did not follow instructions (10%), lack of time (10.5%), and equipment/supplies problems (10%), and refusal to consent (6%). Conclusions According to this study, patients’ unsuitability for surgery, non-compliance with instructions, lack of time, and problems with equipment/supplies are the main reasons for canceling surgery. Proper preoperative assessment and preparation of patients and improved communication between medical teams and patients reduce the cancellation of booked surgeries.
... Operating room costs depend on start time, turnover times, cancellation rates, supplies, equipment and staffing. 11,12 The costing window start date was 180 days before the surgical date and ended 180 days after the surgery date. To ensure full cost capture, and given the limitations of the costing database, which starts on Apr. 1, 2012, and ends on Mar. ...
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Background: Cancer surgery cancellation can have negative consequences for the patient, the surgeon and the health care system. There is a paucity of literature on cancer surgery cancellation and its association with wait times, perioperative outcomes, survival and costs of care. Therefore, the objective of this study was to determine the incidence of same-day cancer surgery cancellation in a universal health care context and its association with short and long-term outcomes. Methods: This was a population-based retrospective cancer cohort study in Ontario, Canada (2010-2016). There were 199 599 patients in the control cohort and 3539 patients in the cohort that experienced a cancellation. We assessed the cohorts for differences in survival, perioperative complications and costs of care. Results: The overall cancellation rate was 1.74% and was predicted by cancer type (genitourinary), lower income quintile, and more central region of residence. Wait times in the cancelled cohort were longer than in the control cohort; however, this difference was not associated with worse survival outcomes. Patients in the cancelled cohort had higher complication rates while in hospital (7.3 %) than those in the control cohort (4.9%; p < 0.01). After adjusting for important confounders, the cancelled cohort was more costly ($1100). Conclusion: Same-day cancer surgery cancellation rates were low. They were associated with longer wait times, higher complication rates and increased costs of care. Survival was not worse in the cancelled cohort, suggesting that appropriate cancer urgency prioritization occurs. Preventable causes of cancellation should be targeted to improve outcomes in patients with cancer.
Article
Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6–3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1–0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21–61 [0–288]) pre-intervention to 31 (20–51 [1–250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.
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Objectives: The aim of this study was to determine the prevalence and reasons for elective dental and oral and maxillofacial surgeries (OMFS) cancellations at a single, tertiary hospital, to determine whether patient demographics are associated with cancellations, and to describe the cancellation phenomenon. Methods: A retrospective record-based study was conducted at a tertiary care hospital in Riyadh from January 2017 to March 2020. For the final analysis, we included 2768 patients who satisfied the inclusion criteria. The descriptive statistics were obtained to investigate the prevalence of elective dental and maxillofacial surgery cancellations at a single, tertiary hospital; we then estimated the overall prevalence and reasons for cancellation across three categories: patient-related reasons, physician-related reasons, and organizational reasons. The Fisher's exact test was performed to evaluate if there were variations in the proportion of reasons for cancellation among participant characteristics and surgical specialties. Results: Out of 2,768 patients who were eligible for OMFS, Pediatric Dentistry, or Special Need Dentistry elective surgeries that have had appointments scheduled at the hospital between January 2017 through March 2020, only 144 patients have had their appointments cancelled. Overall prevalence of cancellation of elective surgeries (CES) is 5.2%. Physician-related cancellation of CES was the highest (66.43%) compared to patient-related (27.86%) and organization-related (5.71%) reasons. Conclusion: Although the CES rate was low compared to the rates reported worldwide, there are some important interventional processes that can help reduce the rate of CES and thereby improve economic efficiency and patient outcomes. Greater attention should be paid to quality improvement strategies, patient adequacy and organizational resources in the early stages of the preoperative period.
Article
Background Cancellation of elective total shoulder arthroplasty (TSA) is an expected occurrence. The typical cost of canceled elective surgeries is estimated to be 3000perpatientandcanleadtohospitallossesofnearly3000 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 healthcare system. The purpose of the study is to identify the frequency and causes of unexpected same-day cancellations in total shoulder arthroplasty and determine which treatment path those patients take following their cancellation. Methods A consecutive series of 1,189 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 cancelled were identified. The etiology of cancellation, time to rescheduling, date of actual TSA procedure, and subsequent work-up were recorded. Descriptive statistics of the cancelled patient cohorts were analyzed. Univariate analysis, chi-square test, and analysis of variance were used to compare patients who cancelled on the day of surgery to prior to surgery. Results Of the 1,189 TSA patients, 964 were TSA for primary glenohumeral osteoarthritis or cuff tear arthropathy. 98 (10.2%) TSA had cancellations, of which 49.0% were on the day of surgery (DOS). Most common causes of DOS cancellations were due to medical reasons (45.8%) and anesthesia-related complication (27.1%). Infection (40.9%) was the most frequent medical reasons for cancellations. 54% of the anesthesia-related complication cancellations underwent additional diagnostic and therapeutic intervention, despite 100 % of those patients receiving preoperative clearance. Discussion Day of surgery cancellations in total shoulder arthroplasty 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. Higher proportion of patients with inadequate medical clearance will cancel prior to day of surgery. Despite preoperative optimization, certain patient risk factors need additional diagnostic and therapeutic interventions prior to undergoing shoulder arthroplasty. Through coordination and planning, healthcare providers and patients can identify those factors and address these issues early on to avoid cancellation and ultimately proceed with a total shoulder arthroplasty.
Article
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Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital. Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions. Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January - December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatre booking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Infoversion 7 was used to analyse the data and derive the descriptive statistics. Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients’ condition improved significantly n=3 (1.3%), nurses’ strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860. Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients.
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Background Cancellation of elective scheduled operations on the day of surgery leads to an inefficient use of operating room (OR) time and a waste of resources. It also causes inconvenience for patients and families. Moreover, day of surgery (DOS) cancellation creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations as well as opportunity costs of lost time and missed income. The objective of this study is to establish the rate of elective surgical cases cancellations on the day of surgery and the reasons for these cancellations stratified by avoidable versus unavoidable within a tertiary care teaching hospital in Beirut, Lebanon as well as recommend appropriate solutions. Method This is a prospective audit of the operation theatre list over a period of eight months (January 1, 2013-August 30, 2013). All patients scheduled to undergo elective surgeries at the hospital from January-August 2013 were included. An assigned OR staff recorded the cancelled cases in real time. The assigned staff confirmed the cancellation reason and added additional explanation if necessary by calling patients or through direct inquiry of clerical and/or clinical staff the following day. A Pareto chart was constructed to prioritize the reasons that accounted for 80 % of the avoidable surgical cancellations. Results For the given study period, 5929 elective surgeries were performed, of which 261 cases (4.4 %) were cancelled on the day of surgery. 187 cases (or 71.6 %) were judged as potentially avoidable cancellations versus 74 (28.4 %) that were judged as unavoidable. Of the 187 potentially avoidable cancellations, lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and OR behind schedule accounted for almost 80 % of the causes. Conclusion This study showed that the majority of cancellations were deemed avoidable and hospital related. A day of surgery cancellation rate less than 2 % is attainable. Determining the major avoidable contributors to DOS cancellations is an essential first step to developing appropriate interventions to improve operating theater efficiency. Recommended interventions were presented accordingly.
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Importance Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. Objectives To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. Design, Setting, and Participants This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Main Outcomes and Measures Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. Results In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was 37.45(37.45 (16.04) in the inpatient setting and 36.14(36.14 (19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting (29.88[29.88 [9.06] vs 38.29[38.29 [16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses (20.40of20.40 of 37.37) in the inpatient setting and 59.1% of total expenses (20.90of20.90 of 35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, 14.00of14.00 of 20.40; ambulatory, 14.35of14.35 of 20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, 2.55of2.55 of 37.37; ambulatory, 3.33of3.33 of 35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. Conclusions and Relevance The mean cost of OR time is 36to36 to 37 per minute, using financial data from California’s short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.
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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 organizations since many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organizing 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 September 1, 2013 to May 31, 2014 (n=591) and from September 2015 to 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 analyzed statistically. Results: Cancellation rates varied between 1.6% and 9.7% (in the first phase) and between 1.5% and 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 to the preoperative protocol was found. Conclusions: A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates. This article is protected by copyright. All rights reserved.
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Surgery cancellations are costly and can be frustrating for patients, their families, and the surgical team. Because of the inherent nature of an ambulatory surgery center, which only performs scheduled elective procedures, surgical cancellations typically result in wasted time and resources. Pediatric surgery cancellations can be mitigated with proper preoperative screening and communication between nurses and patients’ guardians. To reduce the rate of cancellation at our pediatric ambulatory surgery center, we implemented a Nurse-Patient Preoperative Call Log. Preoperative nurses called patients or their guardians on two separate occasions during the two weeks before surgery to review health history and instructions and answer questions about the upcoming surgery. Three months after implementing the call log, surgery cancellation rates significantly decreased from 16.8% to 8.8% (P < .05). Nurses used the call log for all patients, with 85.6% of patients receiving two calls in the two weeks before their surgery.
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Objective: Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice.Methods: We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre’s Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients.Results: Between 2005 and 2009, 1544 out of 19 141 (8.07%) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, process related causes were by far the most common reason for cancellation (58.5%) and “standby” cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected.Conclusions: This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.
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The high-cost/high-revenue environment of the OR requires special attention from managers to scrutinize and reduce costs. In the OR, nonlabor cost savings (ie, no staff member will be laid off or reclassified to realize cost savings) can typically be identified most readily. Operational costs in the OR are affected by start times, turnover times, cancellation rates, and adequate supplies, equipment, and staffing. Inefficiency in the OR can increase costs and lead to dissatisfied patients, physicians, and staff members. This article describes concepts that contribute to efficiency in the OR and illustrates the importance of staff member engagement in achieving desired outcomes.
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Aims and objectives: The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure. Background: The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown. Design: A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis. Results: The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care. Conclusion: A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patient's and the family's needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings. Relevance to clinical practice: A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved.
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Background: Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking. Objective: This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China. Methods: Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR. Results: Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count. Conclusions: Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs.