they trusted with their lives.
Those are avoidable outcomes because most case cancellations are
entirely preventable and often unnecessary. They should be consid-
ered never events, just like a medication error or a wrong-site proce-
dure. You need to identify their causes and determine how to solve
them. Your ultimate goal is to make sure every surgery goes off as
planned.
A call for change
AORN advises surgical facilities to keep their same-day case cancel-
lation rate under 2%. Ours was as high as 4% when we decided to
take a critical look at the problem. The rate is now down to 1%
thanks to over-the-phone assessments of patients conducted by one
of our CRNAs during calls made the day before scheduled cases.
When we began investigating why our same-day cancellation rate
was too high, we zeroed in on a frequent factor — patients would
arrive for their scheduled surgeries, but then be disqualified after the
anesthesiologist's pre-op examination. On the day of surgery, your
anesthesia providers might be looking at labs that are a week old. In
the meantime, they learn the patient's been bleeding, so their hemo-
globin level might be very different. It's determined that the patient
needs blood before surgery. That's another two or three hours of time
your surgeon or your schedule might not have.
When we decided to test the effectiveness of day-before-surgery
patient assessment phone calls, we took 120 cases and split them
evenly into two groups: patients assessed over the phone by a CRNA
and patients who were contacted by a peri-op nurse. Our facility usu-
ally performs 40 to 60 procedures per day, so this was a good sample
size. There were 10 cancellations, a rate of 8.3%, but only two of those
cancellations occurred among patients the CRNA called.
F E B R U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 2 9
