More than one third of all planned orthopaedic surgery procedures are re-booked, postponed or cancelled completely. The most common reasons are cancellation at the patient's own request or emergency cases having to be prioritised. These are the findings of a study carried out by the Sahlgrenska Academy in association with Sahlgrenska University Hospital.
Postponed or cancelled operations are a problem both for the individual patient, who may have to wait longer for treatment, and for the hospital providing treatment in the form of poorer use of resources.
The Department of Orthopaedics at Sahlgrenska University Hospital in Mölndal has now -- together with researchers from the University of Gothenburg's Sahlgrenska Academy -- initiated a research study to map the occurrence of, and identify the reasons for, planned operations being rebooked for new times, postponed until an unspecified time or cancelled completely.
39 percent are cancelled
The study, which reviewed 17,625 booked operations between 2007 and 2011, shows that 39 percent of all planned procedures for joint replacement, arthroscopy or foot and ankle surgery were cancelled or rebooked at least once.
The most common reasons for operations not being carried out as planned were cancellations at the patients' own request for various reasons (33%), the clinic being forced to purchase care from another care-giver due to the treatment guarantee (29%), incomplete pre-operative patient preparation (12%) and emergency patients being prioritised (9%).
Not unique to Sweden
"Many surgical departments carry out planned and emergency procedures in parallel," says Ulla Caesar, a doctoral student at the Sahlgrenska Academy. "This leads to planned operations often having to be rebooked, postponed or 'bought' from another care-giver since emergency operations have to be prioritised. This situation is not unique to Gothenburg and Sweden. Instead, it is probably a general problem for surgical care at all Swedish hospitals."
According to the researchers, having to rebook or cancel operations is sometimes unavoidable. However, the Sahlgrenska Academy study shows that many cancellations could be avoided by ensuring that patients are better prepared and informed before the procedure.
"Here, one good solution would be to apply person-centred care to a greater degree, making the patient more involved in and responsible for his or her own treatment," adds Elisabeth Hansson Olofsson, a researcher at the Sahlgrenska Academy. "Another solution discussed in the study would be to have separate surgical departments for emergency and planned care.
The study has been carried out using an application developed in-house, in which all electronic documentation, such as patient notes and various registers, can be combined and compiled. The results will now provide important data for operational improvements.
"Today, we have fewer rebookings than during the studied period," concludes Magnus Karlsson, Head of Orthopaedics at Sahlgrenska University Hospital. "Unfortunately, however, I fear that we will continue to experience a very large proportion of rebookings as long as patients are unable to book the time of their operations themselves. I believe that patients having a say in the time of their operations would be a significant success factor, making patients feel more involved."
The article Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases was published in the journal Patient Safety in Surgery.
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