PubMed · 6434817
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W van Dijk. 1984. [Data processing as support in the nursing field].. https://pubmed.ncbi.nlm.nih.gov/6434817/
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"Advanced access" is a set of change principles for improved scheduling in office-based health care, widely applied in the United States and in the United Kingdom. Examination of advanced access in two Australian general practices indicates it is feasible in this country and may offer improvements in patient access to care, practice income and workplace conditions. Rigorous evaluations of advanced access are lacking, but in the Australian National Primary Care Collaborative, 300 practices will implement advanced access, providing an opportunity for a rigorous evaluation of these principles.
The problem of surgical waiting lists requires multifactorial solutions.
OBJECTIVE: To establish the rate of and reasons for cancellations of surgery on the scheduled day in an Australian hospital. DESIGN: Prospective survey. SETTING: Major metropolitan tertiary hospital, 13 May to 15 November 2002. MAIN OUTCOME MEASURES: Proportion of operations cancelled on the day of surgery, obtained each day from the operating theatre list and a separate list of additions and cancellations compiled on the day; reasons for cancellations from the cancellation list, extended or confirmed, as necessary, by questioning of bookings and ward staff, or members of the surgical team; estimated and actual duration of each operation and patient information from hospital clinical records. RESULTS: 7913 theatre sessions were scheduled by 133 surgeons in the study period; 941 of these (11.9%) were cancelled on the day, including 724 of 5472 (13.2%) elective procedures on working weekdays. Main reasons for cancellation were: no theatre time due to over-run of previous surgery (18.7%); no postoperative bed (18.1%); cancelled by patient (17.5%); and change in patient clinical status (17.1%). Procedural reasons (including patient not ready, no surgeon, list error, administrative cause, and communication failure) totalled 21.0%. Ear, nose and throat surgery experienced the most cancellations (19.6%), followed by cardiothoracic surgery (15.8%). CONCLUSIONS: There were five major reasons of similar magnitude for on-the-day surgery cancellations. We estimated that 60% of cancellations of elective procedures were potentially avoidable. Change of one factor leading to cancellation (eg, provision of more postoperative beds) is not likely to lead to improvement unless the other major factors are also tackled.