Hovlid Einar, von Plessen Christian, Haug Kjell, Aslaksen Aslak Bjarne, Bukve Oddbjørn
Institute of Social Science, Sogn og Fjordane University College, Postbox 1336851 Sogndal, Norway.
BMC Surg. 2013 Aug 8;13:30. doi: 10.1186/1471-2482-13-30.
The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied how patients experienced interventions to reduce cancellations.
We conducted a comparative, qualitative case study by interviewing 8 patients who had experienced the redesigned pathway, and 8 patients who had experienced the original pathway. We performed a content analysis of the interviews using a theory-based coding scheme. Through a process of coding and condensing, we identified themes of patient experience.
We identified three common themes summarizing patients' positive experiences with the effects of the interventions: the importance of being involved in scheduling time for surgery, individualized preparation before the hospital admission, and relationships with few clinicians during their hospital stay.
Patients appreciated the effects of interventions to reduce cancellations, because they increased their autonomy. Unanticipated consequences were that the telephone reminder created a personalized dialogue and centralization of surgical preparation and discharge processes improved continuity of care. Thus apart from improving surgical logistics, the pathway became more patient-centered.
取消计划中的手术会对患者造成伤害，延长等待时间并浪费稀缺的医疗资源。以往的研究从医疗和管理角度评估了减少手术取消的干预措施；这些措施侧重于成本、住院时间、提高效率以及减少术后并发症。在我们的案例中，一家医院经历了高取消率，因此重新设计了择期手术流程以减少取消情况。我们研究了患者对减少取消手术干预措施的体验。
我们通过采访8名经历了重新设计流程的患者和8名经历了原流程的患者，进行了一项对比性的定性案例研究。我们使用基于理论的编码方案对访谈进行了内容分析。通过编码和提炼过程，我们确定了患者体验的主题。
我们确定了三个共同主题，总结了患者对干预措施效果的积极体验：参与安排手术时间的重要性、入院前的个性化准备以及住院期间与少数临床医生的关系。
患者赞赏减少取消手术干预措施的效果，因为这些措施增加了他们的自主权。意外的结果是电话提醒建立了个性化对话，手术准备和出院流程的集中化改善了护理的连续性。因此，除了改善手术后勤工作外，该流程变得更加以患者为中心。
