Publish Date: May 9, 2018
Same-day cancellations in ASCs carry tangible, negative financial repercussions. When a case cancels on the same day as the scheduled surgery, an ASC is likely to lack adequate time to fill the open OR with another surgery. The facility may be unable to move subsequent cases up, creating gaps in the surgical schedule. This is not an efficient way to run the organization as the ASC still must cover labor and overhead costs.
Physicians feel the financial impact as well. They are unable to perform the scheduled procedure and probably won't have the ability to fill the gap with another patient.
While some same-day cancellations are unavoidable, their numbers can be reduced, says Jamie Ridout, RN, MSN, MBA, NEA-BC, CNOR, administrator of Capital City Surgery Center in Raleigh, N.C. She recommends ASCs take the following three steps to bring these figures down.
Identify causes. Before ASCs can begin trying to reduce same-day cancellations, they must first determine why they are occurring. The causes, Ridout says, are usually clinical in nature.
"Patients may have mistakenly had something to eat or drink too close to their scheduled procedure," she says. "Perhaps, they forgot to stop their blood thinners and/or aspirin within the appropriate time frame prior to surgery. Other reasons can include blood sugars that are elevated, a blood pressure that is too high or a body mass index increase beyond the acceptable range of surgery center criteria."
To target improvement efforts, ASCs need to know which of these or other causes are tied to their own same-day cancellations. "You need to know your data," Ridout says. "Make sure you are tracking the reasons for cancellations via incident reports or some other methodology. Whether you are using electronic systems, which can often make monitoring easier, or paper records, develop the means to track all of the data points that may contribute to cancellations."
Execute strategy. Once you know what is driving your same-day cancellation data, develop a strategy to address the cause(s), taking appropriate steps to help mitigate the cancellations.
"For example, if we saw an uptick of patients being cancelled because they were eating or drinking prior to surgery, we would closely examine our pre-admission patient education process," Ridout says. "We would ensure an extra effort to focus on NPO education and our patients' understanding of it. We might even consider providing day-before-surgery phone calls to remind patients of the eating and drinking rules they need to follow."
Ridout says she would take a similar strategic approach to addressing same-day cancellations attributable to other issues. "We would ramp up our focus on that piece of education or perhaps revise our education in a manner that patients could better understand and/or retain. As another example, for cancellations tied to elevated blood sugar, we may change the course of our pre-operative workup to include pre-day-of-surgery blood sugar testing on patients — even those who are unaware they may have blood sugar problems."
She continues, "There can be a time and cost associated with some improvement strategies, which is why you do not want to be reactive to the data. Rather, take a more tactical approach to decrease cancellations, ensuring your strategy focuses on the specific issues contributing to cancellations."
Measure performance. Executing an improvement strategy does not guarantee an improvement. As the strategy is rolled out, make sure you continue to measure same-day cancellations, focusing closely on the contributor(s) you target for improvement.
If there's little change in the cancellation rate tied to that contributor, you will know your efforts are coming up short of accomplishing their objectives and can consider taking a different approach. If there is a nominal improvement, you may want to weigh additional efforts. If you see a significant improvement, you know your plan is executing on its promise. Your same-day cancellations and subsequent improvement strategies might also be a great quality improvement study for the year.
Avoid ComplacencyAs noted, there are many factors that can contribute to cancellations. A low same-day cancellation rate one period does not assure a low rate the following period. Even in times of strong performance, Ridout says it is imperative for ASCs to track cancellations and work to identify their causes.
"In my professional judgment, you want to keep your same-day cancellation rate below 2 percent," she says. "As much as you want to avoid them, cancellations are inevitably going to happen. And when they do, you should work to determine whether the cancellation was an anomaly attributable to patient error or if you have an internal problem that ultimately can be addressed. If you fail to catch and resolve the problem early, it will contribute to more cancellations. And that means more open times in your surgical schedule, lost revenue and wasted expenses."
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