Seasonal variability in cancellation of neurosurgical cases - an ongoing effort in service improvement
EANS Academy. Levy O. 09/25/19; 275716; EP13003
Dr. Ory Levy
Dr. Ory Levy

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Abstract
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Introduction: A recent study (Wong et al. 2018) found that 13.9% of elective inpatient operations in the UK are cancelled or postponed at the day of surgery. Requirement for post-operative critical care, presence of A&E department, and provision of tertiary services were amongst the most significant risk factors for operative cancellation. These factors are most likely to be present in the context of neurosurgical services.
Methods: We audited the cancellation of neurosurgical procedures in a busy neurosurgical unit (Queen Elizabeth Hospital, Birmingham) during the month of October 2018. This led to a prospective service improvement project reviewing all cancellations with the aim of improved patient experience, improved quality of service provision, and morbidity and mortality reduction.
Results: Our result demonstrates that spinal procedures are more likely to be cancelled than cranial ones. An initial audit showed that emergencies and patient non-attendance were the most significant reason for cancellation. A further on going prospective study of cancellation demonstrated a substantial seasonal variability in the reasons for cancellation. During the winter season neurosurgical cancellations increased, reaching higher rates than other specialities. Lack of beds was an increasing reason for cancellation during that period.
Conclusion: Risk Factors for operative cancellation are inherent within centres providing neurosurgical cases. As a result during a substantial part of the year cases in neurosurgery are more likely to be cancelled than in other specialities. Ensuring optimal care for neurosurgical patients requires an ongoing review of cases cancellation and prospective planning based on historically collected data and expected patient load in the health system during the winter. We suggest that along routine mortality and morbidity data collected routinely in neurosurgical units, cancellation risk data should be collected for improved service provisioning especially during periods were more cancellations are expected.
Introduction: A recent study (Wong et al. 2018) found that 13.9% of elective inpatient operations in the UK are cancelled or postponed at the day of surgery. Requirement for post-operative critical care, presence of A&E department, and provision of tertiary services were amongst the most significant risk factors for operative cancellation. These factors are most likely to be present in the context of neurosurgical services.
Methods: We audited the cancellation of neurosurgical procedures in a busy neurosurgical unit (Queen Elizabeth Hospital, Birmingham) during the month of October 2018. This led to a prospective service improvement project reviewing all cancellations with the aim of improved patient experience, improved quality of service provision, and morbidity and mortality reduction.
Results: Our result demonstrates that spinal procedures are more likely to be cancelled than cranial ones. An initial audit showed that emergencies and patient non-attendance were the most significant reason for cancellation. A further on going prospective study of cancellation demonstrated a substantial seasonal variability in the reasons for cancellation. During the winter season neurosurgical cancellations increased, reaching higher rates than other specialities. Lack of beds was an increasing reason for cancellation during that period.
Conclusion: Risk Factors for operative cancellation are inherent within centres providing neurosurgical cases. As a result during a substantial part of the year cases in neurosurgery are more likely to be cancelled than in other specialities. Ensuring optimal care for neurosurgical patients requires an ongoing review of cases cancellation and prospective planning based on historically collected data and expected patient load in the health system during the winter. We suggest that along routine mortality and morbidity data collected routinely in neurosurgical units, cancellation risk data should be collected for improved service provisioning especially during periods were more cancellations are expected.
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