Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Anesthesia/OR Economics
INTRODUCTION: Cancellations in surgical cases result in inefficient utilization of operating rooms and high hospital costs. Cancellations may also result in a lower quality of patient care and customer satisfaction. For these reasons, an audit was performed to evaluate cancellation rates and to determine the causes for surgical cancellations.
METHODS: A retroactive study was performed on all scheduled surgical cases between January 1, 1993, and December 31, 1996. Causes for cancellation were obtained by the medical center's Automated Data Processing system which generates monthly summary reports of all surgical cases. Data was analyzed by cause, by specialty, by month, and by year. Thirty categories of causes for case cancellation existed at the time of the study. Surgical categories included anesthesiology, cardiology, ENT, general surgery 1 & 2, neurosurgery, opthomology, oral surgery, orthopedics, plastic surgery, podiatry, renal transplants, urology, and an unknown category for surgeries which failed to be classified.
RESULTS: During the four year period, a total of 15,804 surgical cases were scheduled. Of these cases, a total of 3,830 cases were canceled resulting in a total cancellation rate of 24%. Of the thirty possible causes of cancellation, the top five leading causes were: patient no-show, surgeon not available, medical condition, further work-up required, and equipment/instruments not available. Patient no-shows were responsible for almost one-third (30%) of all cancellations, while 15% of all cancellations were attributed to surgeon availability. The patient's medical condition contributed 12% to all cancellations, and another 15% was near evenly split between further work-up required and equipment/instrument availability. Cancellation rates decreased from 26% in 1993, to 22% in 1995. However, rates rose sharply to 25% in 1996. Specialties with the high cancellation rates relative to the number of procedures scheduled were: general surgery 1 (29%), orthopedics (27%), general surgery 2 (26%), and urology (24%). Anesthesiology (63%), renal transplants (29%), and cardiology (27%) also had high cancellation rates, but had significantly lower volumes.
DISCUSSION: Cancellations appeared to be highest during the months of July, August, September, and October which is likely due to the turnover of new surgical residents. No other seasonal or cyclical trends were observed. The percent of cancellations due to patient no-shows appears to be decreasing, however, the cancellation rates due to surgeon availability seems to have risen sharply. Cancellations due to equipment/instrument availability and medicine/cardiology clearance also appears to be problematic. No literature could be found to indicate whether or not the medical center's 24% cancellation rate falls within the average range for hospitals nationwide. One article did site an overall cancellation rate of 17% . If this number is representative of the average, then the medical center's range is certainly well above the mean. In comparison with causes cited in similar studies [1,2], these causes for cancellation appear not to be unique, but rather typical of other hospitals. However, as hospitals are pushed to greater efficiencies and the pursuit of higher patient satisfaction and clinical quality, it is essential that the medical center's operating room also become part of the total quality improvement effort practiced in centers of excellence.