1887
Volume 2014, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Late cancellations of scheduled elective surgery limit the ability of the surgical care service to achieve its goals. Attributes of these cancellations differ between hospitals and regions. The rate of late cancellations of elective surgery conducted in Hamad General Hospital, Doha, Qatar was found to be 13.14% which is similar to rates reported in hospitals elsewhere in the world; although elective surgery is performed six days a week from 7:00 am to 10:00 pm in our hospital. Simple and systematic analysis of these attributes typically provides limited solutions to the cancellation problem. Alternatively, the application of the theory of constraints with its five focusing steps, which analyze the system in its totality, is more likely to provide a better solution to the cancellation problem. To find the constraint, as a first focusing step, we carried out a retrospective and descriptive study using a quantitative approach combined with the Pareto Principle to find the main causes of cancellations, followed by a qualitative approach to find the main and ultimate underlying cause which pointed to the bed crisis. The remaining four focusing steps provided workable and effective solutions to reduce the cancellation rate of elective surgery.

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2014-07-01
2024-03-19
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References

  1. Perroca MG, Jericó MC, Facundin SD. Surgery cancelling at a teaching hospital: implications for cost management. Rev Latino-am Enfermagem. 2007; 15:5:10181024.
    [Google Scholar]
  2. Jonnalagadda R, Walrond ER, Hariharan S, Walrond M, Prasad C. Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country. Int J Clin Pract. 2005; 59:6:716720.
    [Google Scholar]
  3. Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, Klineberg PL. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust. 2005; 182:12:612615.
    [Google Scholar]
  4. Dexter F, Wachtel RE. Analysing day-of-surgery cancellation rates. Anaesth Intensive Care. 2009; 37:5:858 author reply 58-9.
    [Google Scholar]
  5. Gonzalez-Arevalo A, Gomez-Arnau JI, delaCruz FJ, Marzal JM, Ramirez S, Corral EM, García-del-Valle S. Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia. 2009; 64:5:487493.
    [Google Scholar]
  6. Haana V, Sethuraman K, Stephens L, Rosen H, Meara JG. Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J Surg. 2009; 79:9:636640.
    [Google Scholar]
  7. Ahmed T, Khan M, Khan FA. Cancellation of surgery in patients attending the preoperative anaesthesia assessment clinic: a prospective audit. J Pak Med Assoc. 2009; 59:8:547550.
    [Google Scholar]
  8. Hand R, Levin P, Stanziola A. The causes of cancelled elective surgery. Qual Assur Util Rev. 1990; 5::26.
    [Google Scholar]
  9. Seim AR, Fagerhaug T, Ryen SM, Curran P, Saether OD, Myhre HO, Sandberg WS. Causes of cancellations on the day of surgery at two major university hospitals. Surg Innov. 2009; 16:2:173180.
    [Google Scholar]
  10. Yoon SZ, Lee SI, Lee HW, Lim HJ, Yoon SM, Chang SH. The effect of increasing operating room capacity on day-of-surgery cancellation. Anaesth Intensive Care. 2009; 37:2:261266.
    [Google Scholar]
  11. Knox M, Myers E, Hurley M. The impact of pre-operative assessment clinics on elective surgical case cancellations. Surgeon. 2009; 7:2:7678.
    [Google Scholar]
  12. Argo JL, Vick CC, Graham LA, Itani KM, Bishop MJ, Hawn MT. Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement. Am J Surg. 2009; 198:5:600606.
    [Google Scholar]
  13. Ferschl MB, Tung A, Sweitzer B, Huo D, Glick DB. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology. 2005; 103:4:855859.
    [Google Scholar]
  14. Rai MR, Pandit JJ. Day of surgery cancellations after nurse-led pre-assessment in an elective surgical centre: the first 2 years. Anaesthesia. 2003; 58:7:692699.
    [Google Scholar]
  15. van Klei WA, Moons KG, Rutten CL, Schuurhuis A, Knape JT, Kalkman CJ, Grobbee DE. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg. 2002; 94:3:644649.
    [Google Scholar]
  16. Pollard JB, Olson L. Early outpatient preoperative Anaesthesia assessment: does it help to reduce operating room cancellations? Anesth Analg. 1999; 89:2:502505.
    [Google Scholar]
  17. Kleinfeldt AS. Preoperative phone calls. Reducing cancellations in pediatric day surgery. AORN J. 1990; 51:6:15591564.
    [Google Scholar]
  18. Tung A, Dexter F, Jakubczyk S, Glick D. The limited value of sequencing cases based on their probability of cancellation. Anesth Analg. 2010; 111:3:749756.
    [Google Scholar]
  19. Dexter F, Shi P, Epstein R. Descriptive study of case scheduling and cancellations within 1 week of the day of surgery. Anesth Analg. 2012; 115:5:11881195.
    [Google Scholar]
  20. Dexter F, Marcon E, Epstein RH, Ledolter J. Validation of statistical methods to compare cancellation rates on the day of surgery. Anesth Analg. 2005; 101:2:465473, table of contents.
    [Google Scholar]
  21. Goldratt EM, Cox J. The Goal – A Process of Ongoing Improvement. Croton-on-Hudson, NY: North River Press 1984.
    [Google Scholar]
  22. Breen AM, Burton-Houle T, Aron DC. Applying the theory of constraints in health care: Part 1–The philosophy. Qual Manag Health Care. 2002; 10:3:4046.
    [Google Scholar]
  23. Schuster M, Neumann C, Neumann K, Braun J, Geldner G, Martin J, Spies C, Bauer M, for the CASCAES Study Group . The effect of hospital size and surgical service on case cancellation in elective surgery: results from a prospective multicenter study. Anesth Analg. 2011; 113:3:578585.
    [Google Scholar]
  24. Grosfeld A, Ronen B, Kozlovsky N. The Pareto managerial principle: when does it apply? Int J Prod Res. 2007; 45:10:23172325.
    [Google Scholar]
  25. Keranen J, Soini EJ, Ryynanen OP, Hietaniemi K, Keranen U. Economic evaluation comparing from home to operation same day admission and preoperative admission one day prior to the surgery process: a randomized, controlled trial of laparoscopic cholecystectomy. Curr Med Res Opin. 2007; 23:11:27752784.
    [Google Scholar]
  26. Povysil J. [One-day surgery]. Osterr Krankenpflegez. 1986; 39::7881.
    [Google Scholar]
  27. Ranieri E, Caprio G, Fobert MT, Civitelli L, Ceccarelli F, Barberi S, Virno F. One-day surgery in a series of 150 breast cancer patients: efficacy and cost-benefit analysis. Chir Ital. 2004; 56:3:415418.
    [Google Scholar]
  28. Gilliard N, Eggli Y, Halfon P. A methodology to estimate the potential to move inpatient to one day surgery. BMC Health Serv Res. 2006; 6::78.
    [Google Scholar]
  29. Dervin JV, Stone DL, Beck CH. The no-show patient in the model family practice unit. J Fam Pract. 1978; 7:6:11771180.
    [Google Scholar]
  30. Taylor PJ. The no-show patient never has the last appointment of the day. CMAJ. 1991; 144:7:916917.
    [Google Scholar]
  31. Mantyjarvi M. No-show patients in an ophthalmological out-patient department. Acta Ophthalmol (Copenh). 1994; 72:3:284289.
    [Google Scholar]
  32. Stickney P. What works. Telephone reminder system works with patient software to reduce no-show rate. Health Manag Technol. 1997; 18:6:46.
    [Google Scholar]
  33. Guse CE, Richardson L, Carle M, Schmidt K. The effect of exit-interview patient education on no-show rates at a family practice residency clinic. J Am Board Fam Pract. 2003; 16:5:399404.
    [Google Scholar]
  34. Izard T. Managing the habitual no-show patient. Fam Pract Manag. 2005; 12:2:6566.
    [Google Scholar]
  35. Goldstein A. Are your patient no-show strategies robbing you blind? Dent Today. 2009; 28:11:146. 48-49.
    [Google Scholar]
  36. Rittersma J, Casparie AF, Reerink E. Patient information and patient preparation in orthognathic surgery: a medical audit study. J Maxillofac Surg. 1980; 8:3:206209.
    [Google Scholar]
  37. Reading AE. Psychological preparation for surgery: patient recall of information. J Psychosom Res. 1981; 25:1:5762.
    [Google Scholar]
  38. Baskerville PA, Heddle RM, Jarrett PE. Preparation for surgery: information tapes for the patient. Practitioner. 1985; 229:1405:677678.
    [Google Scholar]
  39. Rittersma J. Patient information and patient preparation in orthognathic surgery. The role of an information brochure a medical audit study. J Craniomaxillofac Surg. 1989; 17:6:278279.
    [Google Scholar]
  40. Phipps CG. Effectiveness of the clinical nurse specialist in preadmission testing. Health Matrix. 1987; 5:4:2327.
    [Google Scholar]
  41. Koay CB, Marks NJ. A nurse-led preadmission clinic for elective ENT surgery: the first 8 months. Ann R Coll Surg Engl. 1996; 78:1:1519.
    [Google Scholar]
  42. Gilmartin J. Day surgery: patients' perceptions of a nurse-led preadmission clinic. J Clin Nurs. 2004; 13:2:243250.
    [Google Scholar]
  43. Ferguson J, Alpert JJ. A study of hospital admission rules during pediatric residency training. J Med Educ. 1980; 55:10:876878.
    [Google Scholar]
  44. Siegel SH. How OBRA admission rules affect nursing facilities. Healthc Financ Manage. 1990; 44:9:5253, 56-59.
    [Google Scholar]
  45. Walker BC, Haslett T. The dynamics of local rules in hospital admission processes. Aust Health Rev. 2003; 26:3:98106.
    [Google Scholar]
  46. Dombi WA. Patient admission, service, and discharge: rules to survive by. Caring. 2004; 23:4:1821.
    [Google Scholar]
  47. Farasatkish R, Aghdaii N, Azarfarin R, Yazdanian F. Can preoperative anaesthesia consultation clinic help to reduce operating room cancellation rate of cardiac surgery on the day of surgery? Middle East J Anesthesiol. 2009; 20:1:9396.
    [Google Scholar]
  48. Stepaniak S, Mannaerts G, de Quelerij M, de Vries G. The effect of the operating room coordinator's risk appreciation on operating room efficiency. Anesth Analg. 2009; 108:4:12491256.
    [Google Scholar]
  49. Tessler M, Kleiman S, Huberman M. A “zero tolerance for overtime” increases surgical per case costs. Can J Anaesth. 1997; 44:10:10361041.
    [Google Scholar]
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