Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
Anaesthesia. 2024 Jun;79(6):593-602. doi: 10.1111/anae.16247. Epub 2024 Feb 14.
Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6-3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1-0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21-61 [0-288]) pre-intervention to 31 (20-51 [1-250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.
在计划进行择期手术的 24 小时内取消手术会降低手术室效率，增加不必要的成本，并对患者体验产生负面影响。我们实施了一整套干预措施，旨在减少当天的手术取消。这包括用于提高患者参与度的沟通工具，以及新的筛查工具（自动评估 ASA 身体状况和手术取消风险评分，外加四个筛查问题），以便提前识别（理想情况下在预约手术之前）需要进行全面术前风险分层的患者。我们研究了 2021 年 4 月至 2022 年 12 月在单一中心接受耳鼻喉科日间手术的患者。采用多变量逻辑回归和中断时间序列分析来分析该干预措施对 24 小时内手术取消和成本的影响。我们分析了 1548 例连续预约的病例。在干预前的 929 例（12.3%）病例中，有 114 例在 24 小时内取消，而在干预后的 619 例（8.4%）病例中，有 52 例取消。取消率在第一个月下降了 2.7%（95%CI 1.6-3.7%，p<0.01），随后每月下降 0.2%（95%CI 0.1-0.4%，p<0.01）。这导致估计节省了 15 万美元（11.8755 万英镑；13.837 万欧元）或 35.3%的成本（p<0.01）。在干预前，病例安排和手术日之间的天数中位数（IQR[范围]（0-288））为 34 天，而干预后为 31 天（20-51[1-250]）（p<0.01）。通过电子病历患者门户或短信进行的患者参与度从基线时的 75.9%增加到干预后的 90.8%（p<0.01）。手术取消的主要原因是患者在手术当天失约，从干预前的 7.2%下降到干预后的 4.5%（p=0.03）。麻醉师驱动的基于临床信息学的一整套干预措施可降低计划进行耳鼻喉科日间手术患者的当天手术取消率和相关成本。
