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Archive February 2020 XXI, No. 2

Avoid Costly Case Cancellations

A single pre-op phone call will help to keep your surgical schedule on track.

Natalya Nelson

Natalya Nelson, DNP, RN, CNOR

BIO

FULL STORY
FULL STORY It's not enough to keep a tally of last-minute case cancellations. You also need to keep track of why they happened.

Last-minute cancellations of elective surgeries send negative ripples outward from empty ORs. Surgeons without patients to operate on and facilities with unexpected holes in their schedules lose time and money. Frustrated patients who were physically and mentally primed for surgery lose faith in the providers they trusted with their lives.

Those are avoidable outcomes because most case cancellations are entirely preventable and often unnecessary. They should be considered never events, just like a medication error or a wrong-site procedure. You need to identify their causes and determine how to solve them. Your ultimate goal is to make sure every surgery goes off as planned.

A call for change

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AORN advises surgical facilities to keep their same-day case cancellation rate under 2%. Ours was as high as 4% when we decided to take a critical look at the problem. The rate is now down to 1% thanks to over-the-phone assessments of patients conducted by one of our CRNAs during calls made the day before scheduled cases.

When we began investigating why our same-day cancellation rate was too high, we zeroed in on a frequent factor — patients would arrive for their scheduled surgeries, but then be disqualified after the anesthesiologist's pre-op examination. On the day of surgery, your anesthesia providers might be looking at labs that are a week old. In the meantime, they learn the patient's been bleeding, so their hemoglobin level might be very different. It's determined that the patient needs blood before surgery. That's another two or three hours of time your surgeon or your schedule might not have.

When we decided to test the effectiveness of day-before-surgery patient assessment phone calls, we took 120 cases and split them evenly into two groups: patients assessed over the phone by a CRNA and patients who were contacted by a peri-op nurse. Our facility usually performs 40 to 60 procedures per day, so this was a good sample size. There were 10 cancellations, a rate of 8.3%, but only two of those cancellations occurred among patients the CRNA called.

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