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Cancellation of operations on the day of intended surgery at a major Australian referral hospital

William N Schofield, George L Rubin, Michael Piza, Ying Yin Lai, Doungkamol Sindhusake, Michael R Fearnside and Peter L Klineberg
Med J Aust 2005; 182 (12): 612-615.

Summary

Objective: To establish the rate of and reasons for cancellations of surgery on the scheduled day in an Australian hospital.

Design: Prospective survey.

Setting: Major metropolitan tertiary hospital, 13 May to 15 November 2002.

Main outcome measures: Proportion of operations cancelled on the day of surgery, obtained each day from the operating theatre list and a separate list of additions and cancellations compiled on the day; reasons for cancellations from the cancellation list, extended or confirmed, as necessary, by questioning of bookings and ward staff, or members of the surgical team; estimated and actual duration of each operation and patient information from hospital clinical records.

Results: 7913 theatre sessions were scheduled by 133 surgeons in the study period; 941 of these (11.9%) were cancelled on the day, including 724 of 5472 (13.2%) elective procedures on working weekdays. Main reasons for cancellation were: no theatre time due to over-run of previous surgery (18.7%); no postoperative bed (18.1%); cancelled by patient (17.5%); and change in patient clinical status (17.1%). Procedural reasons (including patient not ready, no surgeon, list error, administrative cause, and communication failure) totalled 21.0%. Ear, nose and throat surgery experienced the most cancellations (19.6%), followed by cardiothoracic surgery (15.8%).

Conclusions: There were five major reasons of similar magnitude for on-the-day surgery cancellations. We estimated that 60% of cancellations of elective procedures were potentially avoidable. Change of one factor leading to cancellation (eg, provision of more postoperative beds) is not likely to lead to improvement unless the other major factors are also tackled.

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  • William N Schofield1
  • George L Rubin2
  • Michael Piza3
  • Ying Yin Lai4
  • Doungkamol Sindhusake5
  • Michael R Fearnside6
  • Peter L Klineberg7

  • 1 Centre for Health Services Research, University of Sydney at Westmead, Sydney, NSW.
  • 2 Department of Surgery, Westmead Hospital, Sydney, NSW.
  • 3 Department of Anaesthesia, Westmead Hospital, Sydney, NSW.

Correspondence: 

Acknowledgements: 

We are grateful to all the hospital staff who assisted in the study; to Ms Janice Labbett (Manager, Operating Suite), Ms Lyn Dahms (Business Manager, Department of Surgery) and Dr Geoff Shead (Surgeon) who sat on the project planning committee (chaired by Professor Michael Fearnside, Head of Surgery); and to Mr Wayne Griffiths, who gave access to theatre data.

This project was undertaken at the Centre for Health Services Research as a quality assurance project using core funding from The Western Sydney Health Service and infrastructure support from the New South Wales Department of Health.

Competing interests:

None identified.

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