AN AUDIT OF REASONS FOR CANCELLATIONS IN ORTHOPAEDIC DAY CASE SURGERY

Abstract

Day case surgery is commonplace in the field of orthopaedic surgery, being suitable for a wide range of both trauma & elective procedures. It became apparent within our unit that an unacceptably high number of cases were being cancelled for a variety of reasons. We set out to identify these reasons and thereby develop a simple screening process to reduce the number of cancellations.

Initial audit over a 1 year period showed 25% of the 907 day case patients were being cancelled. We subdivided the reasons for these cancellations at both pre-operative assessment and on the day of surgery into avoidable [e.g. no carer / telephone, uncontrolled BP, high BMI and ischaemic heart disease] and unavoidable [e.g. surgery no longer required, patient unwell, list cancelled for emergencies, patient DNA].

The majority of our cancellations fell into the “avoidable” category, predominantly at pre-operative assessment. Accordingly, we devised a simple screening questionnaire to be used by clinicians in out-patients at the time of listing for surgery, based on the RCS guidelines (1985). If any of the questions were answered “Yes”, the patient was not suitable for day case surgery. The patient information letter was also changed, informing patients that non-attendance would result in their removal from the waiting list.

Re-audit of 727 patients over the next 12 months showed a fall in cancellations to only 11%, with the majority of these being for unavoidable reasons.

Cancellations are a source of inconvenience, distress and frustration to both clinician and patient, are a waste of hospital time and resources, and lead to an increase in waiting lists. Our study demonstrates the value of closing the loop in audit, leading to a dramatic reduction in cancellations. Audit is a useful tool to improve patient care, and is not merely a “number-crunching” exercise.