Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement

Argo, Joshua L.; Vick, Catherine C.; Graham, Laura A.; Itani, Kamal M.F.; Bishop, Michael J.; Hawn, Mary T.

doi:10.1016/j.amjsurg.2009.07.005

« Previous Next »The American Journal of Surgery
Volume 198, Issue 5 , Pages 600-606, November 2009

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement

Joshua L. Argo, M.D., M.S.P.H.
- Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, 1530 3rd Ave. South, KB 428, Birmingham, AL 35294-0016, USA
Catherine C. Vick, M.S.
- Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, 1530 3rd Ave. South, KB 428, Birmingham, AL 35294-0016, USA
Laura A. Graham, M.P.H.
- Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
Kamal M.F. Itani, M.D.
- Department of Surgery, VA Boston Health Care System, West Roxbury, MA, USA
- Department of Surgery, Boston University, Boston, MA, USA
Michael J. Bishop, M.D.
- Department of Veterans Affairs Central Office, Washington, DC, USA
- Puget Sound VA Health Care System, Seattle, WA, USA
- Department of Anesthesiology, University of Washington, Seattle, WA, USA
Mary T. Hawn, M.D., M.P.H.
- Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, 1530 3rd Ave. South, KB 428, Birmingham, AL 35294-0016, USA
- Corresponding author: Tel.: +1-205-975 1932; fax: +1-205-996 4959

Received 1 May 2009; received in revised form 2 July 2009

Abstract

Background

This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system.

Methods

CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities.

Results

Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive.

Conclusions

Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

Keywords: Surgery, Operating room efficiency, Case cancellation, Quality, Quality improvement