IMPROVING ELECTIVE SURGERY CANCELLATIONS: A QUALITY IMPROVEMENT PROJECT

The purpose of the project was to identify factors associated with elective surgery cancellations (ESCs) on the day of surgery in a multispecialty orthopedic practice and develop recommendations to mitigate these factors. Elective Surgery (ES) Cancellations increase the cost of health care delivery and contribute to patient and family dissatisfaction. The rate of ESCs varies significantly from 1% to 26% across settings. Organizational (perioperative processes) and patient factors (knowledge deficits, communication issues, etc.) contribute to preventable surgical cancellations. A quality improvement (QI) project was conducted in the orthopedic practice in a Southern California facility. A retrospective chart review of the orthopedic ESC cases was performed for the timeframe of January 1, 2015 to December 31, 2015. An analysis of 4,633 ES cases was reviewed and examined. Preventable and unpreventable ESC cases were analyzed using frequency counts and percentages based upon patient and organizational factors. A report of recommendations to address ESCs was created for stakeholders. The QI project found that there were no organizational factors that contributed to ESCs on the day of surgery. It was determined that 1.2% of the ESCs were attributed to patient related factors. The low ESC rate suggests the effectiveness of the orthopedic department’s perioperative care processes. Nonetheless, upon examination of the results, the data showed 3,264 out of 4,633 (70%) cases were cancelled and iv rescheduled more than once. Thus, a considerable amount of perioperative resources was expended during the cancellation and rescheduling process. This project revealed the need for further examination of ESCs to identify the factors associated with multiple cancellations and rescheduling. The institution will need to develop a protocol to decrease any preventable patient or organizational factors that prevent an ES from occurring as scheduled. Decreasing preventable ESCs may improve organization profitability and patient/family satisfaction.