II

Introduction:

Rate of cancellation of elective surgeries on day of surgery is reported world-wide ranging from 1.96-24%^1-2. Cancellation of scheduled elective cases on day of surgery has multiple implications and it implies poor quality of patient care and hospital management. Cancellation on day of surgery leads to both institutional loss by causing waste of operating room time, hospital resources as well as inconvenience to patients and their kin both psychologically and financially due to increased hospital stay, fasting requirements, loss of day wages and the possible need to repeat certain investigations^3-8.

Cancellation of day care procedures posted under anaesthesia also cause similar issues. Many a times day care procedures especially in cancer institute are for diagnostic purpose and delaying these procedures leads to delay in further planning and initiation of cancer therapy. We decided to conduct this audit to find out the current rate of cancellations in our institute, to analyse the causes, classify them into potentially avoidable and unavoidable causes, and furthermore, to suggest the solutions to minimise avoidable causes.

Aim:

Analysis of cancellations in day care procedures

Objectives:

Primary: To calculate the incidence of cancellation of day care procedures needing anaesthesia.

Secondary:

1) Root cause analysis of the individual cancellation.

2) Classification of causes of cancellations into avoidable and unavoidable

Methodology:

Design: A prospective observational study.

Sample size: Patients recruited over a period of four months or 500 patients, whichever is earlier. 

After IEC approval and CTRI registration, the recruitment will proceed, to include all those patients who had cancellations on the day of surgery, when planned day care procedures under anaesthesia.

 Sites: This is a single-centre study.

We will get the record of all the cases posted for day care procedures from the registration counter of minor OT. If any case which was initially posted under anaesthesia but the procedure gets cancelled for that day then that case will be included in the study.

The reason for cancellations along with the demographics of the patient will be recorded. We will also screen for documentation of pre-procedure instructions on the electronic medical record (EMR), and patients’ file. The details from the pre anaesthesia check up if any will also be recorded.

Reason for cancellation with their opinion will be noted in the CRF by OT anaesthetist and surgeons separately. And also we will record suggestions to avoid such postponement in future by both OT anaesthetist and surgeron. Their opinion and suggestion will be completely voluntary and their willingness to give their suggestions will be considered as their consent.

At the end we will analyse all the details of the causes of cancellation of day care procedure and try to find out the corrective measures for the avoidable causes.

Statistical Analysis Plan: Descriptive data will be analyzed using frequencies and percentages for categorical variable and mean and standard deviation/ median (IQR) from continuous variables.