Introduction
Pooled lists, as part of a Single-Entry Model (SEM), aim to reduce elective daysurgery post-pandemic backlogs by increasing case throughput. However, patients often do not meet their surgeon until the day of surgery. Thus, we often miss the gold-standard of consent - a two-way discussion in advance, free from pressure, considering the patient's best interests. Furthermore, delays of over two years from listing are common, during which clinical indications may change, and may go unchecked.
A high rate of on-the-day cancellations was noted in the General Surgery cohort of our elective Surgical Hub, who routinely use pooled lists. We hypothesised that same-day review and consent contribute to increased cancellations. An analysis of cancellation reasons was performed, and a pilot consent clinic was introduced.
Methods
On-the-day cancellations were analysed over 30 weeks, covering 500 sessions. Two surgeons piloted a model in which patients were reviewed and consented in pre-existing clinic sessions two weeks prior to surgery, in line with the 6-4-2 scheduling model. Cancellations were monitored for eight weeks postintervention.
Results
General Surgery accounted for 22% of on-the-day cancellations, with a 17% rate (106 of 521 cases). Leading reasons included: patient did not attend (8%), list overrunning (8%), case complexity (6%), unrelated illness (5%), and incorrect preop preparation (5%). Notably, 5% lacked clinical indication for surgery. Postintervention, cancellations significantly reduced across all metrics. Consent clinics were acceptable to both patients and surgeons.
Conclusion
This low-resource, scalable model improves list efficiency and strengthens
patient-centred care within SEMs for elective day surgery.
Authors
Georgia Geary
University Hospital Llandough, Cardiff, United Kingdom
Alice Jones
University Hospital Llandough, Cardiff, United Kingdom
Ryan Trickett
University Hospital Llandough, Cardiff, United Kingdom