Key result
Quality improvement interventions, including a pre-anesthesia evaluation clinic and tailored anesthetic plans, reduced the rate of elective surgical cancellations from 1.08% to 0.67%.
Why the study?
Surgical cancellation is a chief cause of operating room underutilization, prompting an evaluation of medical concerns accountable for cancellations at a large tertiary care hospital in Maharashtra, India.
Do quality improvement interventions using the PDSA cycle reduce the rate of elective surgical cancellations?
Do quality improvement interventions using the PDSA cycle reduce the rate of elective surgical cancellations?
Absolute Event Rate: 0.67% vs 1.08%
Implementation of a PDSA-based quality improvement project, including pre-anesthesia clinics and tailored anesthetic plans, successfully reduced elective surgical cancellations.
Targeted preoperative interventions may lower cancellation rates; leaves open whether similar QI projects broadly improve OR utilization.
Background The operating room (OR) is a critical facility that consumes a significant percentage of the hospital's resources, so it must be used judiciously. Surgical cancellation is a chief cause of OR underutilization. The purpose of this study was to hold medical concerns accountable for surgical cancellations at a large tertiary care hospital in Maharashtra, India. Methods The Plan, Do, Study, and Act (PDSA) cycle is a tool for analyzing change and learning via action. We used this method to determine the origins of errors, identify key points, and test change interventions such as an individually tailored anesthetic plan, provision of a pre-anesthesia evaluation clinic in the outpatient department, reevaluating patients, and rechecking the preoperative checklist. This study was undertaken as a part of a quality improvement project at our hospital in India. All elective surgical operations scheduled between January and November 2020 were included, and canceled procedures were investigated to identify potential reasons. Results During the auditing period, 7,709 elective operations were scheduled; 68 (0.88%) of them were canceled. After piloting interventions, the rate of cancellations dropped from 1.08% to 0.67% in the succeeding cycle. A root cause analysis of the data revealed that there was a 7.1% decrease in cancellations due to hypertension, a 3.8% decrease due to insufficient routine blood tests, and a 1.9% decrease in the inappropriate preoperative workup, while we saw an increase in fever (5.5%) and blood sugar level (1.9%) discrepancies. Conclusions Dr. D. Y. Patil Hospital & Research Centre in Pune, India, had cancellations in scheduled ORs due to associated medical co-morbidity that were potentially reducible post-intervention and could be replicated for application in various tertiary care hospitals. Regular monthly audits, quality improvement projects, and the designation of an organized system may enhance the proper utilization of the OR which could potentially save funds, preserve resources, alleviate the burden of patients, and reduce cancellations to a minimum.
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Pattnaik et al. (2022) studied Elective surgical operations (n=7,709). Quality improvement interventions vs. Pre-intervention period was evaluated on Rate of surgical cancellations. Quality improvement interventions, including a pre-anesthesia evaluation clinic and tailored anesthetic plans, reduced the rate of elective surgical cancellations from 1.08% to 0.67%.
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