J. W. Vehawn1, D. M. Ferguson1, S. A. Arshad1, S. A. Ceron1, A. A. Noorbaksh1, E. I. Garcia1, N. B. Hebballi1, K. Tsao1 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA
Introduction: Operative delays and cancellations reduce efficiency and waste resources, while decreasing patient/guardian satisfaction. We hypothesized that the majority of pediatric same-day cancellations and operative delays at our institution are preventable. We aimed to describe current rates and causes of operative cancellations and delays.
Methods: We conducted a retrospective review of all outpatient pediatric surgeries scheduled November 2018-April 2019. All pediatric surgeries were included except for fetal surgeries. Cancellations were defined as cancellations on the same calendar day as the scheduled surgery. Delays were defined as patient arrival in the operating room >5 minutes after the scheduled start. Only first-start cases were evaluated for delays, as later delays may be secondary to a first-start delay. Cancellations and delays were classified as readily preventable, potentially preventable, or non-preventable. Readily preventable factors were defined as those that occurring due to a flaw in or lack of adherence to the current system. Potentially preventable factors were defined as those that would require a new system in order to prevent them. Descriptive statistics were used.
Results: Of 1129 scheduled operations, 102 (9%) were cancelled. Cancellations were attributed to changes in patient health status (41%), parent/patient request (24%), patient no-show (19%), surgeon request (5%), need for additional workup (3%), and financial/insurance reasons (3%). Of 469 first-start cases, 82 (17%) were delayed. Reasons for delay included surgeon tardiness (20%); documentation issues, including missing preoperative note or consent (20%); parent questions (15%); need for medical care unrelated to the planned procedure (11%); equipment problems/unavailability (9%); patient tardiness (7%); and need for an interpreter (4%). The remaining cancellations and delays were due to infrequent reasons (n≤2). Readily preventable factors accounted for 33% of cancellations and 75% of delays. These included tardiness (patient or surgeon), no-shows, need for additional workup, surgeon request, financial/insurance reasons, parent questions, and issues with documentation, equipment, or interpreters. Potentially preventable reasons included change in patient health status and parent/patient request. No reason for cancellation or delay was found to be non-preventable.
Conclusions: Many cancellations and delays were avoidable, with 33% of cancellations and 75% of delays determined to be readily preventable. Modification of the preoperative process at our institution, such as using automated reminder texts and/or calls, may drastically reduce no-shows and late arrivals. Penalizing surgeons for their contribution to tardiness or incomplete documentation may improve surgeon-related factors. Other factors, such as a change in the patient’s health status prior to surgery, may require more complex interventions like telemedicine visits with anesthesiology.