Cancelled elective operations: an observational study from a district general hospital

PURPOSE: Cancelled operations are a major drain on health resources: 8 per cent of scheduled elective operations are cancelled nationally, within 24 hours of surgery. The aim of this study is to define the extent of this problem in one Trust, and suggest strategies to reduce the cancellation rate. DESIGN/METHODOLOGY/APPROACH: A prospective survey was conducted over a 12-month period to identify cancelled day case and in-patient elective operations. A dedicated nurse practitioner was employed for this purpose, ensuring that the reasons for cancellation and the timing in relation to surgery were identified. The reasons for cancellation were grouped into patient-related reasons, hospital clinical reasons and hospital non-clinical reasons. FINDINGS: In total, 13,455 operations were undertaken during the research period and 1,916 (14 per cent) cancellations were recorded, of which 615 were day cases and 1,301 in-patients: 45 per cent (n = 867) of cancellations were within 24 hours of surgery; 51 per cent of cancellations were due to patient-related reasons; 34 per cent were cancelled for non-clinical reasons; and 15 per cent for clinical reasons. The common reasons for cancellation were inconvenient appointment (18.5 per cent), list over-running (16 per cent), the patients thought that they were unfit for surgery (12.2 per cent) and emergencies and trauma (9.4 per cent). PRACTICAL IMPLICATIONS: This study demonstrates that 14 per cent of elective operations are cancelled, nearly half of which are within 24 hours of surgery. The cancellation rates could be significantly improved by directing resources to address patient-related causes and hospital non-clinical causes. ORIGINALITY/VALUE: This paper is of value in that it is demonstrated that most cancellations of elective operations are due to patient-related causes and several changes are suggested to try and limit the impact of these cancellations on elective operating lists.