Elective day of surgery (DOS) cancellations are a common problem that causes operating rooms to lie empty, frustrates patients, wastes staff time, and extends hospital stays.
The financial impact can vary, but most of the healthcare organizations we work with recognize the need for reducing the rate of same-day cancellations. At a cancellation rate of 4.7%, day of surgery cancellations can cost US$ 1.4 million a year. In one estimate, for each percentage point of reduced cancellation, a single OR can deliver $100,000+ in savings to a hospital or surgery center. So imagine if you have 10 operating rooms, then that’s already $1 million in revenue.
While the reasons vary per hospital, in general, most of these cancellations are preventable. Among the avoidable reasons are lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and operating rooms running behind schedule.
Let’s tackle these reasons.
Lack of financial clearance
One of the most common avoidable reasons for cancellation is a lack of financial clearance on the day of the surgery. This typically occurs as a result of inadequate coordination between the financial clearance and operating room staff, as well as not clearly defining a specific deadline for financial clearance prior to surgery days.
Some hospitals still use manual or outdated processes like fax that create room for coordination errors, such as lost H&Ps. Others have digital tools for scheduling operating rooms but they aren’t connected with the surgeons and financial clearance systems, and still require ad hoc coordination outside of these tools, which can exacerbate coordination errors.
In Navicent Health in Georgia, with 637 beds and 60 O.R.s, we solved this by putting in place a system that has the following criteria:
- A digital system to manage the schedule of operating rooms, including a portal where in-network and partner surgeons can reserve operating rooms
- Plug-and-play interconnectivity between the surgeons, operating room scheduling system, and financial clearance system
- Automatic cancellation at a set amount of time prior to the surgery if there is no financial clearance and notification of the affected parties
Incomplete medical evaluation
We’ve also found incomplete or mischeduled pre-admission tests to be a common cause of same-day elective surgery cancellation. This happens when hospitals don’t have clear timelines of tests before surgery—including bottlenecks and latest allowable dates. In other cases, they have scheduling criteria but have no quick way to visualize which procedures are due or overdue, which ones are prerequisites to other procedures, and which ones are pending results. As a result, this creates poor patient experiences where the patient shows up but can’t proceed with surgery.
There are two components needed to address this cause: the first one is a visualization tool similar to a GANTT chart or kanban board that clearly indicates the procedures required to be finished for each person prior to a surgery, when they should be completed, and who is responsible. This tool should connect to all involved systems so that it is always updated as to the status of each procedure and test result. The second component is a notification system that automatically follows up all involved parties especially if they have upcoming or missed deadlines. In case the follow ups are insufficient, the scheduling system should flag the surgery at a sufficient lead time, e.g. one day prior, so that the O.R. can be freed up on that day for other surgeries and the preparations aren’t wasted.
Patient didn’t show up for surgery
There can be a number of reasons for patients failing to present on the day of surgery. Cold feet about the procedure is tricky to address, but forgetting about or confusion about the schedule is entirely preventable with a systematic means of notification and follow-up. Among the hospitals we work with, we see a large variation of scheduling tools and notification systems, but the main issue we’ve seen time and time again is the lack of connectivity between their different tools. As a result, even when they do support scheduled follow ups via multiple channels (email, SMS, phone call), there is still no meaningful coordination across their systems that would make the notification system effective.
OR behind schedule
Another common cause of day of surgery cancellations is lack of OR time due to emergency surgeries or previous surgeries that have over-run their time due to underestimation. Block scheduling has been hailed as the solution to scheduling problems, but if not executed well, can exacerbate underutilization.
Optimizing OR scheduling requires the ability to collect data about previous surgeries. We then use this data to avoid conflicts initially, but later on enhance the systems to better predict schedules, and provide real-time charts that are pushed to surgeons so they can view their own performance relative to their own past and relative to other surgeons. In many hospitals, one or more of these components is missing. They could still be using fax-based or siloed systems for scheduling, which prevents data from being consolidated and harnessed adequately.
Day of surgery cancellations cause inefficiencies and frustration, but since most of the causes are entirely avoidable, there’s no need to live with them. The key things to solve the most common causes are:
- Interconnectivity across systems through a coordination platform
- Automatic notifications and follow ups for all parties—including surgeons, staff, and patients
- Effective tools to visualize the entire process from pre-assessment to surgery
- Accurate and real-time charts to analyze O.R. and surgeon performance
It’s been satisfying to see how these components have helped hospitals we worked with to dramatically reduce their same-day cancellation rates. In Navicent Health, having a good system to communicate between staff, surgeons, and patients was a win-win for everyone. We’d be delighted to discuss how we can apply these solutions to your hospital.