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      Cancelled elective operations an observational study from a district general hospital

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          Abstract

          Purpose

          Cancelled operations are a major drain on health resources 8 per cent of scheduled elective operations are cancelled nationally, within 24 hours of surgery. The aim of this study is to define the extent of this problem in one Trust, and suggest strategies to reduce the cancellation rate.

          Designmethodologyapproach

          A prospective survey was conducted over a 12month period to identify cancelled day case and inpatient elective operations. A dedicated nurse practitioner was employed for this purpose, ensuring that the reasons for cancellation and the timing in relation to surgery were identified. The reasons for cancellation were grouped into patientrelated reasons, hospital clinical reasons and hospital nonclinical reasons.

          Findings

          In total, 13,455 operations were undertaken during the research period and 1,916 14 per cent cancellations were recorded, of which 615 were day cases and 1,301 inpatients 45 per cent n867 of cancellations were within 24 hours of surgery 51 per cent of cancellations were due to patientrelated reasons 34 per cent were cancelled for nonclinical reasons and 15 per cent for clinical reasons. The common reasons for cancellation were inconvenient appointment 18.5 per cent, list overrunning 16 per cent, the patients thought that they were unfit for surgery 12.2 per cent and emergencies and trauma 9.4 per cent.

          Practical implications

          This study demonstrates that 14 per cent of elective operations are cancelled, nearly half of which are within 24 hours of surgery. The cancellation rates could be significantly improved by directing resources to address patientrelated causes and hospital nonclinical causes.

          Originalityvalue

          This paper is of value in that it is demonstrated that most cancellations of elective operations are due to patientrelated causes and several changes are suggested to try and limit the impact of these cancellations on elective operating lists.

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          Most cited references4

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          Total joint replacement: implication of cancelled operations for hospital costs and waiting list management.

          To identify aspects of provision of total joint replacements which could be improved.
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            Separating elective and emergency surgical care (the emergency team).

            The purpose of this study was to evaluate the influence on general surgical activity following the separation of elective from emergency surgical care in one large teaching hospital. A prospective audit of elective and emergency general surgical activity between 1994 and 1999 inclusive was carried out. Elective and emergency surgical activity was separated in January 1996, with a dedicated 'Emergency Team' of one consultant for one week, two registrars, two senior house officers and four house officers for two weeks, in addition to a 20 bed acute admission ward and a 24 hour emergency theatre. The consultant cancelled the majority of his/her elective work during the on-call week. A prospective collection was made of all elective and emergency operations carried out between 1994 and 1999 using the Lothian Surgical Audit system. Out of hours operative activity was analysed retrospectively from data collected using the Operating Room Schedule of Surgery (ORSOS) and outpatient clinic and day case activity collected from the Hospital Administration System. Comparisons were made between years 1994/1995 and 1996/7/8/9. Emergency surgical admissions rose by 86% from 1973 patients in 1994 to 3675 in 1999. During the same period, elective in-patient activity remained fairly steady, but there was an increase in day surgery from 469 to 2089 cases per annum. Despite the on-call consultant cancelling his/her outpatient clinics, overall outpatient activity also increased from 9911 to 12,335. However a proportion of this reflects the appointment of two new consultants in April 1998. Emergency operations increased from 941 in 1994 to 1351 in 1999, with a two-fold reduction in operations carried out between 0000-0800 hours from 16% in 1994 to 7.9% in 1999. A separate and dedicated 'Emergency Team' is an efficient method of managing acute general surgical admissions. It permits elective work to carry on uninterrupted, reduces the number of operations performed after midnight, and provides a better environment for teaching and training. This scenario might also be applicable to other medical specialties who have a large emergency commitment.
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              Can patient satisfaction with decisions predict compliance with surgery?

              Patient satisfaction with treatment decisions is a discrete and measurable component of the satisfaction paradigm, distinct from satisfaction with health care services. The study goal was to determine if the Satisfaction With Decision (SWD) scale, a valid and reliable 6-item survey, can predict patient compliance with surgery proposed by their otolaryngologist. Prospective study using the SWD scale plus measures of office visit satisfaction, provider satisfaction, and disease-specific quality of life. Metropolitan, private nonprofit hospital. The study population consisted of 151 patients scheduled for surgery, with a median age of 5.8 years and an age range of 0.6 to 65.3 years. At the time surgery was scheduled, the decision-maker completed a 12-item questionnaire about satisfaction and quality of life that included the SWD scale. Noncompliant patients were contacted, and the specific reason for cancellation was ascertained. The strongest predictor of surgical cancellation was the SWD survey score, with a median value of 4.8 for patients completing surgery compared with 3.8 for those who cancelled (P or =4.0 had a 98% completion rate. Patients were also more likely to cancel if it was their first visit with the surgeon (P = 0.004) or if they were responsible for their own decisions (P = 0.007). Cancellations were not associated with office visit satisfaction, patient quality of life, or demographic characteristics of the decision-maker. Patients who are satisfied with their initial decision to undergo surgery are most likely to comply with planned therapy. Conversely, patients who score <4.0 on the SWD scale may benefit from additional preoperative counseling to increase the likelihood of compliance.
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                Author and article information

                Contributors
                Journal
                jhom
                10.1108/jhom
                Journal of Health Organization and Management
                Emerald Publishing
                1477-7266
                27 March 2007
                : 21
                : 1
                : 54-58
                Affiliations
                Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
                Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
                Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
                Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
                Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
                Article
                0250210104.pdf 0250210104
                10.1108/14777260710732268
                17455812
                e95e7d9d-0391-4645-94bb-1f2a5d77bf35
                © Emerald Group Publishing Limited
                History
                Categories
                research-article, Research paper
                cat-HSC, Health & social care
                cat-HMAN, Healthcare management
                Custom metadata
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                yes
                included

                Health & Social care
                Patients,Surgery,Forward scheduling,National Health Service,Hospital management,Clinical audit

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