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: Cancelation of ambulatory surgery on the day of surgery can be disruptive to the operating room schedule, costly to the hospital and distressing to patients and staff. Large academic medical centers often are faced with unpredictably high cancelation rates. We developed an ambulatory cancelation form to track reasons for cancelation on the day of surgery.
METHOD: The Ambulatory Surgery Quality Assurance Committee meets monthly to review indicators, unanticipated admissions and cancelations. Reasons for cancelation included: (1) attending surgeon unavailable; (2) schedule conflict; (3) surgery not indicated; (4) patient illness; (5) lack of proper consent; (6) positive pregnancy test; (7) disallowed drugs; (8) surgery refused; (9) no escort; (10) perioperative event; (11) financial; (12) need for specialist consultation; (13) preoperative testing incomplete or abnormal results; (14) violation of NPO status; (15) no show. This form was made part of the medical record (with copies to surgeon, and ambulatory surgery unit) to assure that the reason for cancelation would be corrected. Cancelations were analyzed according to reasons and surgical specialties.
RESULTS: Data presented reflect use of the ambulatory surgery cancelation form from 7/96 to 7/97. During this time the cancelation rate (total canceled=600/total performed=12,023) ranged from 2.4-8.3%. Greatest reasons for cancelation were: no show (49%) and patient illness (12%). Miscommunication of rescheduled surgery time was a common complaint of the no show patients. Using the corrected cancelation rate (#canceled/#performed), cancelations were equally shared among the surgical services (ranging from 1-21%). Dental surgery which had a cancelation rate of 21% also had the greatest number of pediatric patients.
DISCUSSION: A multifaceted approach was developed to reduce the number of no show cancelations. Staff was dedicated to calling patients prior to surgery. An improved process was implemented for surgeons to report possible cancelations, so that the OR schedule could be adjusted prior to the day of surgery. (Figure 1)