Day of surgery cancellation rates in urology: Identification of modifiable factors
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Résumé
OBJECTIVE: Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice. METHODS: We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients. RESULTS: Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, process-related causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected. CONCLUSIONS: This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle