Reducing cancelation rate of planned elective interventional pain procedure at NCCCR

Cancer Pain Management Department : Qatar

Background/Purpose

Cancellations are a source of inconvenience, distress and frustration to both clinician and patient; it’s also, a waste of hospital time and resources, and lead to an

increase in waiting lists (1). Elective interventional cases cancellation refers to any interventional procedure case that is booked into the operation theatre list on the

day prior to procedure, but is canceled on scheduled day. The reasons for cancellation of elective surgical cases are many; they are as unique as they are similar.

In this small audit we set out to identify these reasons and thereby develop a simple intervention to reduce the number of cancellations.

.

Methods

1-Study design an setting

-This is a prospective observational hospital based

audit done between 1st January 2016 and 30

December, 2016. The audit was conducted in a 88

beds in oncology hospital with one operation theatre

(OT) which provide elective surgical to cancer patients.

The audit included all those patients who were posted

for elective interventional procedure over a period of

one year. Cancelled cases were identified from

predesigned OT utilization formats and the reasons for

cancellation were assessed through an audit tool which

was developed by pain team. In this small audit we set

out to identify these reasons of cancelation and thereby

develop a simple intervention to reduce the number of

cancellations. The initial audit done for the first six

months (January to June, 2016 ) and the second audit

conducted after intervention (from July to December,

2016) .it’s indeed for quality improvement analysis that

we applied the" audit technique" based on triple steps

(Review -Intervention- Evaluation).

2-Using audit and feedback to health professionals to

improve the qualityand safety of health care

Audit and feedback is widely used as a strategy to

improve professional practice either on its own or as a

component of multifaceted quality improvement

interventions. This is based on the belief that

healthcare professionals are prompted to modify their

practice when given performance feedback showing

that their clinical practice is inconsistent with a

desirable target. Despite its prevalence as a quality

improvement strategy, there remains uncertainty

regarding both the effectiveness of audit and feedback

in improving healthcare practice and the characteristics

of audit and feedback that lead to greater impact.

Results Goals / Objectives

The goal of this small audit was;

1- To identify the reasons of cancelation

2- To develop appropriate intervention in order to

reduce the rate of cancelation

3-To assess the effects of audit and feedback on the

practice of healthcare professionals and patient

outcomes and to examine factors that may explain

variation in the effectiveness of audit and feedback.

Audit Cycle

Variables N %

Gender

Female 49 92%

Male 27 8%

Nationality

Qatari 13 17%

Non-Qatari 63 83%

Age

≤ 40 year 36 47%

> 40 year 40 53%

Primary site of disease

Hematology 60 79%

Oncology 16 21%

Type of Procedure at NCCCR

MBB Diagnostic 19 29%

Sacroiliac joint injections 8 12%

Nerve Root diagnostic 1 2%

Caudal epidural 4 6%

Suprascapular nerve block+ Acromioclavicular joint

injection 14 22%

Ultrasound Guided Injection 2 3%

Stellate ganglion block 2 3%

Acromio-Clavicular Joint Injections 1 2%

Steroid injections 3 5%

Greater occipital nerve block 2 3%

Impar gangelion injection 8 12%

Infraorbital nerve block 1 2%

Current Year:

2016

Analysis/Action:

Jan-16 Analysis/Findings: one procedure from 2 was

cancelled.

1/2 Action Plan: to analyze the data and identify

the cause.

50%

Feb-16 Analysis/Findings: 5 procedures from 10

were cancelled.

5/10 Action Plan: to analyze the data and identify

the cause.

50%

Mar-16 Analysis/Findings: one procedure from 9 was

cancelled.

1/9 Action Plan: to analyze the data and identify

the cause.

11%

Apr-16 Analysis/Findings: 4 procedures from 7 were

cancelled.

4/7 Action Plan: to analyze the data and identify

the cause.

57%

May-16 Analysis/Findings: 4 procedures from 10

were cancelled.

4/10 Action Plan: to analyze the data and identify

the cause.

40%

Jun-16 Analysis/Finding: 1 procedure from 7 were

cancelled 1/7

14% Current Year:

2016

Analysis/Action:

July 16

1/4

25%

Analysis/Findings: one

procedure from 4 was

cancelled.

Action Plan: to analyze the data

and identify the cause.

AUG 16

3/12

25%

Analysis/Findings: 3 procedures

from 12 were cancelled.

Action Plan: to analyze the data

and identify the cause.

September 16 Analysis/Findings: one case

was done no cancelation

October 16 Analysis/Findings: one

procedure done there was no

cancelation

November 16

1/4

25%

Analysis/Findings: 1 procedure

from 4 were cancelled.

Action Plan: to analyze the data

and identify the cause.

Dec 16 Analysis/Finding:3 procedure

done there was no cancelation

• Physician spend long time explaining the procedure to patients

• CNS introduced to see the patient at day care before procedure

• Improve patient engagement by involving him/her more in care plan

• The effective utilization of the call system services was reinforced.

35%

20%

First semester2016

Secondsemester 2016

Parameter first semster

Second

semester

Number of Interventional

procedures(N) 52 24

Procedures done (N) 36 19

Procedure cancelled (N) 16 5

50% 50%

11%

57%

30%

14%

67%

25%

0% 0%

25%

0% 0%

20%40%60%80%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

Perc

en

tag

e%

Calendar Time (Months)

Cancellation of booked elective pain procedure is a

common problem across all hospitals in our country and

around the world (1). The incidence of cancellation of

elective procedure has been reported in literature to

range from 20% to 40% [1,2,3]. This audit shows decrease

cancelation by 15% after a minor intervention done by

pain team.

Conclusion

Recommendation

Pamphlet was developed by pain team and waiting for

approval

CNS clinic was established in order to provide adequate

education and addressing patients’ concern.

References 1. Chiu, C. H., Lee, A., & Chui, P. T. (2012). Cancellation of elective operations on the day of intended surgery in a Hong

Kong hospital: point prevalence and reasons. Hong Kong Med J, 18(1), 5-10.

2.Narouze, S., Benzon, H. T., Provenzano, D. A., Buvanendran, A., De Andres, J., Deer, T. R., ... & Huntoon, M. A. (2015).

Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the

american society of regional anesthesia and pain medicine, the European society of regional anaesthesia and pain

therapy, the american academy of pain medicine, the international neuromodulation society, the north american

neuromodulation society, and the world institute of pain. Regional anesthesia and pain medicine, 40(3), 182-212.

3.Ojo E.O., Ihezue C.H (2008). An Audit of Day Case Cancellations In A Nigerian Tertiary Hospital Based Day Case Unit

East and Central African Journal of Surgery; 13 (2); 150- 153.

Team member :

Ms. Khadra Yassin , Mr. Hafedh Ghazouani

Dr. Ahmed Fayed Ahmed El Geziry , Dr. Wael Saleem

Mr. Atef Mansour Mrawweh Al Tawafsheh, Ms. Mariamma Thomas