Implementation of Preoperative Optimization Checklists to Minimize Elective Surgery Case Cancellations

Abstract

Problem: Same day surgery cancellations continue to burden hospitals and the nation’s health care system. On average, up to 20% of ambulatory surgical cases nationwide are cancelled annually. A medium sized community hospital has a yearly cancellation rate of 8%. A root cause analysis has determined the high rate of delayed and cancelled surgical cases is due primarily to inadequate preoperative planning and patient optimization. If nothing is done to address this problem, there will continue to be a loss of revenue, waste of resources, and potential negative consequences for patients. Purpose: The purpose of this quality improvement project was to develop and implement preoperative checklists for the anesthesia staff to use prior to scheduled surgery to assess patients’ readiness for surgery and to identify any remaining necessary testing or screening based on commonly encountered comorbidities. Methods: This quality improvement project took place over 15 weeks, from August to December 2022. The checklist was used by anesthesia staff members during their preoperative chart review of the patient’s electronic chart one to three days prior to surgery. If the checklist revealed missing information, the provider ordered necessary testing, lab work, or consults to be conducted before or on the morning of surgery. Results and conclusions: 35% of patients were screened with the checklist weekly. 13 orders were placed weekly based on missing items identified by the checklist The baseline cancellation rate in August 2022 of 5.1% increased to 9.7% in September 2022 and the final cancellation rate in December 2022 was 5.8%. The preoperative checklist creates a systematic yet individualized screening process for patients scheduled for elective surgery presenting with multiple comorbidities, which can increase the safety of patients undergoing surgery and anesthesia.