Reasons for day of surgery cancellations: Identifying trends to improve efficiency
The percentage of cancelled elective operations is a key performance indictor (KPI) of a hospital's performance . NHS England mandates that all NHS Trusts report the number of non-clinical last minute cancellations . Hospitals are not mandated to report the number of clinical cancellations. We retrospectively audited the number and reasons for clinical and non-clinical cancellations at Royal Derby Hospital (RDH), a large district general hospital. Methods This was a retrospective audit of all clinical and non-clinical cancellations at RDH from 1 April 2015 to 31 March 2016 using validated data from Information Governance cross-referenced with entries recorded in Operation Room Management Information System (ORMIS) and electronic cases notes to assess the reasons for cancellation and identify trends. Results A total of 34,922 elective operations occurred in the audited period. Of these, 906 days of surgery cancellations were identified after analysis: 443 clinical cancellations, 427 non-clinical and 36 patient cancellations occurring on the day of surgery were identified. Reasons for clinical cancellations were pre-existing medical conditions 36% (159), acute illness 34% (152), and patient unfit for surgery 12% (53), operation not necessary 10% (46) and pre-op advice not followed 7% (33). Lack of staff and lack of time accounted for 35% each (150 and 148) of non-clinical cancellations followed by lack of beds 11% (42), lack of equipment 7% (30) and administrative error 5% (22). Twenty patients were not treated within 28 days of a last minute cancellation. The overall rates for both clinical and non-clinical cancellations were both 1.2%. Discussion Percentage day of surgery cancellations at RDH for non-clinical reasons were below the national average . Quality can be improved by optimising management of pre-existing conditions and pre-op advice via current pre-operative assessment clinics. Increased collaboration with GPs and surgeons ensuring all required investigations are completed and results available is paramount to ensure the operation is still required. Lack of staff, beds and time limit efficient theatre utilisation were further reasons for cancellations . The number of dedicated NCEPOD theatres at RDH should be increased at times of high demand. Inconsistencies in how cancellations had been coded resulted in duplication and misclassification. Training, allocating specific staff for data entry and modifications to pre-existing cancellation reasons will ensure reliable and accurate data capture. (Figure Presented).