Incidence and Reasons for a Surgical Cancellation at a Hospital in Rwanda

BackgroundSurgery cancellation is a challenging and costly event resulting in operating theatre inefficiency and psychological and financial problems for the patients and their families. This study aimed to find out the incidence and reasons for surgical cancellation at a Rwandan hospital.MethodsA retrospective study was conducted on 736 patients’ files obtained from theatre registry lists of surgical operations done from January to March 2017. The American Association of Perioperative Nurses (AORN) checklist for documenting cancelled surgical cases was used to establish the rate and reasons for cancellation. Data were analyzed using frequency and percentage descriptive statistics.ResultsOut of the 736 surgeries booked, 179 (24.3%) were cancelled as follows: Orthopedic and general surgeries (28.2%) respectively, gynecology and obstetrics (27.4%), urology surgeries (15.5%), maxillofacial surgeries (15.9%), ENT (15.6%) and plastic surgeries (13.3%). Time constrain/long list (19.6%), acute change in medical status (10.6%), non-turn-up of the patient (8.4%), and abnormal lab findings (7.8%) were the most prevalent reasons.ConclusionThe surgical cancellation rate at the study hospital was 24%, increasing with the number of patients booked and the type of surgical procedure. A prospective study is required to gain more insight into the reason for cancellations, mostly amenable to mitigation measures.Rwanda J Med Health Sci 2021;4(3):379-386

Abstract 140: Customizable Solution for Heart Failure (HF) Care Standardization and Optimization: HF Readmission Performance and Economic Value in the McLaren Flint Hospital Pilot

Introduction: Preventing readmissions after an index HF hospitalization, alongside other hospitalization types, has become a formal Medicare quality metric linked to payment penalties. Similar international incentives exist internationally; under different delivery systems and models, payment for the subsequent admission may be reduced (sometimes even eliminated), or, only the most costly event is paid. McLaren Flint, a teaching facility in the fully integrated McLaren Health Care (MHC) delivery system, concerned with their readmission rate, proactively implemented an integrated Medtronic HF solution as part of its strategic objective to deliver healthcare value measured by quality outcomes and cost. The program, now titled CONNECT-HF®, is customizable and deploys experts, sophisticated technologies, and Lean Sigma techniques to optimize and standardize care. Several improvement areas were identified. Targeted interventions (inpatient process optimizations, standardization of inpatient admission/discharge order sets, training) began implementation Oct 2014. Hypothesis: The program would result to reductions in 30-day readmits and positive financial impact to McLaren. Methods: We conducted before/after comparisons of readmit rates after “index” HF events, comparing Jan-Mar 2015 rates with the ones from the 3-month period before (Oct-Dec 2014). To adjust for seasonality, rates were also compared to the respective period the year before (Jan-Mar 2014). Results: During Jan-Mar 2015, 14 readmits followed 90 index HF hospitalizations vs. 29 readmits after 112 “indexes” over Oct-Dec 2014. This leads to a reduction from 25.9% to 15.6% (RR 39.93%). Jan-Mar 2014 equivalent rate was 21.05% leading to a RR of 26.11% in that comparison. These put McLaren Flint on track to outperform the current 22.7% national rate, the 23.86% previous performance and potentially eliminate the penalty contribution of HF. Potential savings model out to over $154K vs the actual penalty in FY2015 ( 44.6% of total). Conclusions: HF care pathway standardization and optimization can yield significant improvement on HF 30-day readmit rates, saving costs.