IMPACT OF AUDIT AND POLICY IMPLEMENTATION ON ELECTIVE CASE CANCELLATION RATE: A RETROSPECTIVE STUDY

SWATI JAYANTH PAWAR; RANI P; HEMANTHKUMAR VR

doi:10.22159/ajpcr.2022.v15i6.44563

Authors

SWATI JAYANTH PAWAR Faculty in administration, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India.
RANI P Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India.
HEMANTHKUMAR VR Faculty in administration, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i6.44563

Keywords:

Case cancellation, Elective surgical case, Surgery related cancellation, Anesthesia related cancellation, Operation theater utilization

Abstract

Objectives: Cancellation of elective posted case on the day of surgery is the most distressing news for the patient and their wards and also leads to wastage of hospital resources. Cancellation of elective surgical case is a preventable situation, if the involved team members take necessary steps suitable for successful conduct of surgery. This study was done to assess whether audit of case cancellation and policies implemented have reduced the rate of case cancellation.

Methods: This audit was conducted for the past 3 years (2016–2018) in tertiary care hospital with 1500 beds and 12 functional elective operating rooms distributed among eleven specialties. Case cancellation done after the case was posted in the list was considered for the audit. With the consensus of both the surgeon and anesthesiologist, cancelled cases were entered in the cancellation form with the reasons specified. The forms were collected at the end of the day. Cancellations were discussed in operation theater (OT) committee meeting and new policies were made and remedial measures were taken.

Results: Total numbers of elective posted cases were 6094, 5623, and 5353 and case cancellation rate was 8%, 5.6%, and 5.7% in 2016, 2017, 2018, respectively. Patient-related factors were 4.45%, 2.86%, and 3.51%, surgery-related were 2.3%, 1.5%, and 1.21%, anesthesia-related were 0.07%, 0.21%, and 0.3% and infrastructure-related cancellation rate was 1.3%, 1.07%, and 0.69%, respectively. The cancellation rates have been decreased with statistical significance of p<0.00001.

Conclusion: Regular audit of OT utilization and policy implementation will significantly reduce the avoidable causes of case cancellation.

Downloads

Download data is not yet available.

Author Biographies

SWATI JAYANTH PAWAR, Faculty in administration, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India.

DMS,( Broad specialities, marketing and outreach activities) ,

HEMANTHKUMAR VR, Faculty in administration, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India.

Professor and head

Department of Anaesthesiology

References

Xue W, Yan Z, Barnett R, Fleisher L, Liu R. Dynamics of elective case cancellation for inpatient and outpatient in an academic center. J Anesth Clin Res 2013;4:314. PMID 24286019

Sung WC, Chou AH, Liao CC, Yang MW, Chang CJ. Operation cancellation at Chang Gung memorial hospital. Chang Gung Med J 2010;33:568-75. PMID 20979708

Kumar R, Gandhi R. Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. J Anaesthesiol Clin Pharmacol 2012;28:66-9. doi: 10.4103/0970-9185.92442, PMID 22345949

Zafar A, Mufti TS, Griffin S, Ahmed S, Ansari JA. Cancelled elective general surgical operation in Ayub teaching hospital. J Ayub Med Coll Abbottabad. 2007;19:64-6. PMID 18444594

Vinukondaiah K, Ananthakrishnan N, Ravishankar M. Audit of operation theatre utilization in general surgery. Nati Med J India 2000;13:118-21.

Paschoal ML, Gatto MA. Rate of surgery cancellation at a university hospital and reasons for patients’ absence from the planned surgery. Rev Lat-Am Enferm 2006;14:48-53. doi: 10.1590/s0104- 11692006000100007, PMID 16532239

Lee CM, Rodgers C, Oh AK, Muckler VC. Reducing surgery cancellations at a pediatric ambulatory surgery center. AORN J 2017;105:384-91. doi: 10.1016/j.aorn.2017.01.011, PMID 28336027

Turunen E, Miettinen M, Setälä L, Vehviläinen-Julkunen K. The impact of a structured preoperative protocol on day of surgery cancellations. J Clin Nurs 2018;27:288-305. doi: 10.1111/jocn.13896, PMID 28544205

Seim AR, Fagerhaug T, Ryen SM, Curran P, Saether OD, Myhre HO, et al. Causes of cancellations on the day of surgery at two major university hospitals. Surg Innov 2009;16:173-80.

Hussain AM, Khan FA. Anaesthetic reasons for cancellation of elective surgical inpatients on the day of surgery in a teaching hospital. J Pak Med Assoc 2005;55:374-8. PMID 16302470

Sanjay P, Dodds A, Miller E, Arumugam PJ, Woodward A. Cancelled elective operations: an observational study from a district general hospital. J Health Organ Manag 2007;21:54-8. doi: 10.1108/14777260710732268, PMID 17455812

Pandit JJ, Carey A. Estimating the duration of common elective operations: Implications of operating list management. Anaesthesia 2006;61:768-76.

Schuster M, Neumann C, Neumann K, et al. The effect of hospital size and surgical service on case cancellation in elective surgery. Results from a prospective multicenter study. Anesth Analg 2011;113:578-85.

Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, et al. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust 2005;182:612-5. doi: 10.5694/j.1326-5377.2005.tb06846.x, PMID 15963016

Lacqua MJ, Evans JT. Cancelled elective surgery: An evaluation. Am Surg 1994;60:809-11. PMID 7978670