Yu Kaiye, Xie Xiaolei, Luo Li, Gong Renrong
Department of Industrial Engineering, Tsinghua University, Beijing, China.
Department of Industrial Engineering and Engineering Management, Service Management Institute, Business School of Sichuan University, Chengdu, China.
BMC Surg. 2017 Sep 11;17(1):100. doi: 10.1186/s12893-017-0296-9.
Case cancellation (CC) has significant impact on the efficiency of operating room (OR) management, which can be mitigated by taking preventive measures. In this study, using the data of the West China Hospital (WCH), we identified the effect of contributing factors and recommended hospital interventions to facilitate CC prevention.
We conducted a retrospective review of 11,331 elective surgical cases from January 1 to December 31, 2014. CC reasons were grouped into six categories. The methods of descriptive statistics and hypothesis test were used to identify the effect of factors.
CC reasons (746) were divided into six broad categories: workup related (preoperative diagnostic assessment issues or sudden medical condition changes) (25.8%), non-specified reasons (25.8%), coordination issues (15.1%), patient related (13.0%), support system issues (11.8%), and doctor related (8.5%). The types of the most frequently performed operations are identified, as well as their CRs. The cancellation rate (CR) of males was lower than that of females (16.7% to 18.3%). A large difference in the CRs existed among doctors. The CR on Monday was significantly higher than the other four weekdays.
Workup related issues, the types of procedures, the menstrual cycle of females, highly imbalanced CRs among doctors, and tendency of cancellation on Monday are the major identified factors, which account for a significant amount of preventable cancellations. It is suggested that corresponding hospital interventions can reduce CR and improve OR efficiency, including maintaining effective coordination, good communication and well-designed preoperative assessment processes, focusing on the type of procedures which are more time-consuming and complex, paying special attention to the physiology of females during surgery planning, taking measures to reduce CR of top eight doctors, and improving surgery scheduling on Monday.
病例取消（CC）对手术室（OR）管理效率有重大影响，可通过采取预防措施来减轻。在本研究中，我们利用华西医院（WCH）的数据，确定了促成因素的影响，并推荐了医院干预措施以促进CC预防。
我们对2014年1月1日至12月31日期间的11331例择期手术病例进行了回顾性研究。CC原因分为六类。使用描述性统计和假设检验方法来确定因素的影响。
CC原因（746例）分为六大类：检查相关（术前诊断评估问题或突发病情变化）（25.8%）、未明确原因（25.8%）、协调问题（15.1%）、患者相关（13.0%）、支持系统问题（11.8%）和医生相关（8.5%）。确定了最常进行的手术类型及其取消率（CR）。男性的取消率低于女性（16.7%对18.3%）。医生之间的CR存在很大差异。周一的CR明显高于其他四个工作日。
检查相关问题、手术类型、女性月经周期、医生之间高度不均衡的CR以及周一的取消倾向是主要确定的因素，这些因素导致了大量可预防的取消。建议采取相应的医院干预措施以降低CR并提高手术室效率，包括保持有效的协调、良好的沟通和精心设计的术前评估流程，关注耗时且复杂的手术类型，在手术规划时特别关注女性的生理状况，采取措施降低前八位医生的CR，以及改善周一的手术安排。
