CANCELED OPERATIONS IN A TEACHING HOSPITAL IN SAUDI-ARABIA

Cancelled operations are not infrequent, can annoy patients and waste hospital resources. They were monitored prospectively to determine the ir frequency, causes and any impact of surveillance-by-objective plus in-house education. The study involved nine departments and was done i n three phases over 47 consecutive months. During the study period 19 661 operations were performed and 1976 (9.1%) were cancelled, the rate s in Phases 1, 2, and 3 being 11.8%, 6.7% and 6.2%. The difference bet ween Phase 1 and Phase 2 was significant (p<0.001) but that between Ph ase 2 and Phase 3 was not. The study was not designed to influence pat ients, and the frequency of cancellations they had caused remained unc hanged at 2.6%, 1.8% and 1.8%. Nurses contributed least (1.4%) to the burden of cancellations at a frequency of 0.14%, 0.12% and only 0.04% respectively. Medical staff contributed most (over 70%) and their thre e most frequent reasons, which also proved resistant to change, were c o-morbid slates, overbooking and blood not available. Surveillance ach ieved the desired impact in five other reasons for cancellation which became virtually eliminated, viz. anaesthetist or surgeon unavailable, the difficult intubation, medical students' examination, no consent f orms and the arbitrary cancellation. We conclude that the frequency of cancelled operations can be reduced significantly by surveillance but it should include targeting surgeons as individuals by name. However, there were two limitations. No impact occurred when physicians' perce ption was that medico-legal issues were involved, and once the interve ntion stops any improvements achieved can disappear.