Most Last Minute Surgery Cancellations Could Be Avoided
A recent study has shown that almost 12 per cent of scheduled surgical operations were cancelled at the last minute - on the day the surgery was to have taken place - at a major Sydney hospital.
In an article in the latest issue of the Medical Journal of Australia, William Schofield and colleagues from the Centre for Health Services Research at the University of Sydney describe their study to establish the rate and reasons for late cancellations of surgery.
Late cancellations of scheduled operations are a major problem for most hospitals. They are a major cause of inefficient use of operating room time and waste resources. They are also stressful for patients, and costly in terms of working days lost due to rescheduling and disruption to daily life.
The authors studied the operating theatre bookings for both elective and non-elective surgery over a six-month period in 2002 and determined the cancellation rate and reasons for cancellations from information entered on theatre lists and further questioning of hospital staff.
Of the 7913 theatre sessions scheduled by 133 surgeons, 941 (11.9 per cent) were cancelled on the scheduled day of surgery, including 724 or 13.2 per cent of elective procedures on working weekdays.
The most common reasons for on-the-day cancellations were lack of theatre time due to over-run of previous surgery, lack of a postoperative bed, patient cancellation and change in the patient's clinical condition.
Procedural reasons were responsible for 21 per cent of cancellations, including the patient not being ready (eg, had not fasted or has not had appropriate investigations), and theatre list error.
Ear nose and throat surgery experienced the highest rate of late cancellations (19.6 per cent) followed by cardiothoracic surgery (15.8 per cent).
The authors believe that over 60 per cent of cancellations for elective surgery could have been avoided if better procedures were implemented.
"Our results imply that hospitals will not succeed in reducing the rate of on-the-day cancellations unless they tackle each problem in the process", say the authors.
In the same issue of the Journal, Dr Patrick Cregan, Chair of the NSW Department of Health Surgical Services Taskforce and Surgeon at Nepean Hospital, Sydney, said that with effective management, the only day-of-surgery cancellations should be occasional patients with an acute change in their medical condition.
"Managing elective surgery more efficiently requires a well thought out management system, with quarantining of resources to ensure patient flow.
"Currently, 1 per cent of the NSW population is on a surgical waiting list, with similar figures in other states and territories. We have clear evidence of the harm that excessive waiting times cause patients. All available means must be used to solve this problem. Above all, there is a need to avoid the distress caused to patients by day-of-surgery cancellations," Dr Cregan said.
CONTACT William SCHOFIELD 0438 738 815 / 02 9845 6677
Dr Patrick CREGAN 0414 393 252 / 02 4721 4489
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471