Picture this, you stroll into the hospital at the start of your shift, ready to take on your surgeries and patients for the day. But wait… the patient hasn’t arrived. Same-day cancellations have struck again. What could have possibly gone wrong? Let’s take a closer look.
As the healthcare industry changes, we are driven to improve efficiencies. Staffing is monitored daily for productivity. We need to work within a systematic program to reduce waste and frustration. Evaluating day-of-surgery cancelled cases can reduce the financial burden to our site, contributing to improved bottom lines. Effective collaboration with the perioperative team is essential, ongoing monitoring of dashboards and a willingness to change is key to a successful perioperative program.
Many reasons can contribute to day-of-surgery cancellations. Some we can control, some we can’t. The first step to understanding the causes of cancellations in your facility is to define and evaluate the problem. Cancellation codes should be developed in your Electronic Medical Record (EMR) for ease of reporting and grouping the primary source of the cancelled reason.
Utilize a Quality/Lean Daily Management board to log each cancelled case and the reason. Summarize monthly and differentiate between avoidable and unavoidable reasons. Collaborate with PAT, Ambulatory staff and OR staff to develop the cancel reasons appropriate for your facility. Measure your cancel rate and cause and develop a dashboard for continued monitoring. Once you have uncovered the underlying reasons for the Same Day Cancellations, you can move forward with developing an action plan.
Creating your action plan
Create a team of peers from each area of your perioperative team including; PAT, scheduling, Ambulatory or Same Day Surgery, OR, anesthesia, recovery room, sterile supply and patient registration. This Performance Improvement Team (PIT) will identify opportunities to address the avoidable cancel cases. This PIT should meet weekly and should develop process changes using LEAN and Six Sigma processes. Each process change needs to be presented to key stakeholders for review and input for implementation.
Another integral piece to reducing Same-day cancellations is patient readiness. Not only from PAT, but from each area of perioperative services. The perioperative team should develop an effective daily huddle at the close of the next day’s schedule. The final schedule should be brought to the group and be reviewed case by case for proper scheduling, case duration, supplies, implants, conflict with trays and equipment, correct preference card, patient readiness and pre-surgical orders.
Patient history and physical should be in place, necessitating only an update. Patients that are not ready, or supplies not at hand, should be moved from the first case of the day to an appropriate time. Not only will this process decrease your day-of-surgery cancel rate, but will also improve your First Case On-Time Starts.
A third tactic to ensure a reduction in cancellations is to implement reminder calls to the patient the afternoon or evening prior to the surgery. These calls can alert you to a change in the patient’s status and allow you to clarify instructions.
Another key piece that should not be overlooked is working closely with your anesthesia providers to develop standard testing guidelines based on case complexity and patient co-morbidities or health status. As identified by the PAT staff using the agreed protocols, patients needing screening and clearances can be directed to the appropriate physician for pre-surgical evaluation. This will provide on time clearances, successful review of test and laboratory values, avoiding day-of-surgery testing and cancelled cases.
