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Statistical process control for cancelled operations at the paediatric surgery department of a university hospital
Moataza M Abdel Wahab1, Nagwa Y Abou El-Enein
1Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt. moatazamahmoud@yahoo.com.
Insights
Cancelled paediatric surgeries averaged 25%, with most avoidable. Key reasons include patients unfit for anesthesia and infections. Improving pre-operative assessments and communication can reduce cancellations.
Area of Science:
- Paediatric Surgery
- Healthcare Management
- Quality Improvement
Background:
- Cancelled operations lead to delayed patient care and resource underutilization.
- Last-minute cancellations cause significant anxiety for patients and families, especially in pediatric cases.
Purpose of the Study:
- To determine the cancellation rate of planned surgeries on the day of operation.
- To identify the primary causes of surgical cancellations in a pediatric surgery department.
Main Methods:
- A cross-sectional study involving interviews with pediatric surgeons and anesthesiologists.
- Analysis of 181 daily operation sheets to calculate cancellation rates and causes.
- Utilized a p-chart to analyze variations in the cancellation rate.
Main Results:
- The overall surgical cancellation rate was approximately 25%.
- A significant majority (64.4%) of cancellations were due to avoidable causes.
- Common reasons included patient unfitness for anesthesia (electrolyte imbalance, low hemoglobin, fever), chest infections, and no-shows by patients or staff.
Conclusions:
- Implementing outpatient pre-operative assessments is recommended to improve patient readiness.
- Enhancing communication among patients, doctors, and nurses is crucial for reducing cancellations.
- Systemic improvements are needed to address avoidable causes of surgical cancellations in pediatric settings.
Background:
Being a cause of delayed patient management and underutilization of resources, cancelled operations are considered a low quality service. Moreover, anticipation of surgery is stressful for both patients and families, particularly if the patient is a child; additional anxiety posed by last-minute cancellation is, therefore, of primary concern.
Objectives:
The present study was done to estimate the rate and explore the determinant causes of cancellation of planned operations on the day of surgery at the paediatric surgery department of a university hospital in Alexandria.
Methods:
A cross sectional study was performed, interviewing some paediatric surgeons and anaesthesiologists practising at the hospital to collect in depth information about causes of cancelled operations, in addition to revising daily operation sheets for 181 operations to calculate cancellation rate and causes of cancelled operations. To Study patterns of variation in cancellation rate, a control chart (p-chart) was drawn.
Results:
The overall cancellation rate was almost 25%. Analysis of the control chart showed an average cancellation rate of 25%, upper control limit of 74% and a Lower control limit of zero. Of the cancelled operations, 64.4% were of avoidable causes. Pareto chart showed that not being fit for anaesthesia either for electrolyte disturbances, low haemoglobin level or fever was the commonest reason for cancellation of operation, followed by patient having chest infection and patient or doctors not showing on the day of operation (those formed more than 85% of causes).
Conclusion And Recommendations:
Implementation of outpatient preoperative assessment and preparation for surgery, in addition to the improvement of communication between patient, doctors and nurses are highly recommended.
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