Optimizing Preoperative Assessment Timing to Reduce Surgical Cancellations: A Quality Improvement Project

Area of Science:

• Healthcare Management
• Surgical Operations
• Quality Improvement

Background:

• Elective surgery cancellations are a significant drain on healthcare resources, causing increased costs and longer patient waiting lists.
• Cancellations often stem from late preoperative assessments leading to inadequate patient optimization or incomplete investigations.
• Preoperative assessment clinics are crucial for timely medical optimization and ensuring all necessary tests are completed before surgery.

Purpose of the Study:

• To evaluate the impact of earlier preoperative assessments on reducing cancellations for elective surgeries.
• To assess the effect of shifting assessment timing on operating theater efficiency and resource utilization.

Main Methods:

• A quality improvement project was conducted comparing two cycles of preoperative assessments at a public hospital in Pakistan.
• Cycle 1 involved assessments performed ≤1 hour before surgery; Cycle 2 involved assessments ≥24 hours before surgery.
• Data on elective surgical cases (orthopedics, general surgery, ENT) were collected, focusing on postponement rates due to inadequate optimization or incomplete work-up, and wasted bed days.

Main Results:

• The rate of postponements due to inadequate optimization or incomplete laboratory work-up decreased from 6.1% to 3.0% (p = 0.02), a 50% relative risk reduction.
• Wasted bed days per 100 patients significantly reduced from 20.1 to 6.8.
• The shift to earlier assessments demonstrated a statistically significant improvement in surgical scheduling efficiency.

Conclusions:

• Conducting preoperative assessments at least 24 hours prior to elective surgery effectively halved avoidable cancellations.
• This intervention led to substantial reductions in wasted bed days and enhanced overall operating theater efficiency.
• The findings highlight a low-cost, high-impact strategy for improving healthcare system performance, particularly in resource-constrained environments.