Predicting Same Day Surgery Cancellations
Kiersten M. Craig, MD/MSE, Jennifer Sauser, APRN-CNP, Amber Wessendorf, APRN, CNP, Stephanie Burwinkel, BSN, RN, CPN, Theresa Kohne, BSN,RN, CPN, Stacy Levi, MBA, BSN, RN, CPN, Pramod Reddy, MD, Andrew Strine, MD/MPH, Michael Daugherty, MD, MHI.
Cincinnati Children's Hospital, Cincinnati, OH, USA.
BACKGROUND: Same day surgery cancellations are a source of frustration for patients, surgeons, and hospital staff alike. These cancellations result in wasted healthcare resources including decreased surgeon productivity, operating room utilization, and lost work/school hours. The significance of this waste may be disproportionally burdensome to lower socioeconomic families. As such, efforts to improve case completion improves equitable healthcare access and was recently highlighted as an initiative in our institution. At our institution, outpatients are called by our nursing team preoperatively to discuss pre-operative surgery recommendations including NPO time and assessment of health status. We hypothesized that patients who do not receive their preoperative instructions are more likely to have a same day cancellation.
Methods: All urologic cases from a single institution from January 2021 to October 2022 were retrospectively reviewed. Cases cancelled prior to the day of surgery, adjusted cases, and cases for inpatients were excluded. Patient demographics, prior cancellation of clinic visits/operative procedures, SDS pre-operative details were collected. The reason for cancellation was also documented. We compared preoperative clinic information between the case completion and case cancelled group. Statistical analysis was done through R with Chi Square to identify factors that significantly correlated with case cancellation.
Results: A total of 1607 patients were initially scheduled for urologic surgery at our institution. 454 cases were excluded, leaving 1,153 cases for analysis. Of these, 1032 were completed surgeries and 121 were SDSC. All patients received a pre-operative call. Patients/Parents in cancelled cases were 1.8 fold more likely than completed cases to only be reached by message (43% vs 23%) and 5.7 fold more likely to not have a voicemail available (3.3% vs 0.6%). Patients/Parents with completed cases were more likely to be reached at the time of SDS call 76% vs 54%. The top three reasons for case cancellation were for patient illness (35/121), no show (23/121), NPO violation (23/121). For these cancelled cases, families were not reached preoperatively in 28.6% of ill patients, 78.3% of no-show cases, and 39.1% of NPO violations. Race, insurance status, binary clinic no-show rate, prior surgery outcome, SDS contact, and patient illness significantly differed between cases completed and cancelled.
Conclusions: Our data reveals factors that may help predict surgical cancellations so that patients at risk can be identified pre-operatively with targeted resources directed to mitigate SDS cancellation. In addition, to optimizing patient care delivery these SDSC represent a potential lost revenue of over $605,000 during this time frame.
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