Background
In breast surgery, on-the-day cancellations (OTDC) can lead to delays in breast cancer treatment and reconstructive surgery, as well as preventing optimal timing of surgery following completion of neoadjuvant chemotherapy. Furthermore, OTDC leads to suboptimal efficiency of theatre-use, increases surgical waiting lists and financial losses for surgical departments. This closedloop service evaluation aimed to ascertain and improved the OTDC rate in one breast surgery department.
Methods
Records of patients scheduled to undergo elective breast surgery under general anaesthetic between 16/10/2023 and 15/01/2024 were retrospectively reviewed (Cycle 1). OTDC were identified and cancellation reasons noted. Weekly reviews of medical histories and pre-operative assessments were conducted for patients scheduled for theatre. Patients at risk of cancellation or requiring further optimisation were highlighted at a weekly Consultants Meeting list review. A post-intervention audit was conducted between 06/02/2024 and 26/04/2024 (Cycle 2).
Results
In cycle one, 139 breast procedures were scheduled with 13 OTDC (9.4%). Six (4.3%) were deemed avoidable due to failure to address pre-operative medical optimisation. Seven cancellations were deemed unavoidable (e.g. theatre temperature, patient choice). During Cycle 2, 115 breast procedures were scheduled. Eighteen cases were deemed at risk of OTDC. Seven were proactively managed and medically optimised to avoid OTDC. The remaining 11 had insufficient time for medical optimisation and were rescheduled. Overall, there were no OTDC in Cycle 2.
Conclusion
Avoidable OTDC successfully reduced to 0% during the study period. Further improvement includes scheduling earlier pre-operative assessments and timely identification of high-risk patients.
Authors
Bingxuan Wang
Charing Cross Hospital, London, United Kingdom
Serena Patel
Charing Cross Hospital, London, United Kingdom
Katy Hogben
Charing Cross Hospital, London, United Kingdom
Daniel Leff
Charing Cross Hospital, London, United Kingdom
Meera Joshi
Charing Cross Hospital, London, United Kingdom
Hirah Rizki
Charing Cross Hospital, London, United Kingdom
Paul Thiruchelvam
Charing Cross Hospital, London, United Kingdom
Ronak Patel
Charing Cross Hospital, London, United Kingdom