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Open Access Research article

A new pathway for elective surgery to reduce cancellation rates

Einar Hovlid12*, Oddbjørn Bukve1, Kjell Haug2, Aslak Bjarne Aslaksen34 and Christian von Plessen567

Author Affiliations

1 Institute of Social Science, Sogn og Fjordane University College, Postbox 133, 6851, Sogndal, Norway

2 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

3 Department of Radiology, Haukeland University Hospital, Bergen, Norway

4 Institute of Surgical sciences, University of Bergen, Bergen, Norway

5 Department of Thoracic Medicine & Infectious Disease, Hillerød Hospital, Hillerød, Denmark

6 Institute of Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

7 Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway

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BMC Health Services Research 2012, 12:154  doi:10.1186/1472-6963-12-154

Published: 11 June 2012

Abstract

Background

The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery and explored which factors affected the outcomes.

Methods

We collected the number of planned operations, performed operations, and cancellations per month from the hospital’s patient administrative system. We then used Student's t-test to analyze differences in cancellation rates (CRs) before and after interventions and a u-chart to analyze whether the improvements were sustained. We also conducted semi-structured interviews with employees of the hospital to explore the changes in the surgical pathway and the factors that facilitated these changes.

Results

The mean CR was reduced from 8.5% to 4.9% (95% CI for mean reduction 2.6-4.5, p < 0.001). The reduction in the CR was sustained over a period of 26 months after the interventions. The median number of operations performed per month increased by 17% (p = 0.04). A clear improvement strategy, involvement of frontline clinicians, introduction of an electronic scheduling system, and engagement of middle managers were important factors for the success of the interventions.

Conclusion

The redesign of the old clinical pathway contributed to a sustained reduction in cancellations and an increased number of performed operations.

Keywords:
Quality improvement; Process redesign; Cancellation of surgery; and Health information technology