[Elective surgery--cancellations, ring fencing and efficiency].
BACKGROUND
We set out to study to what extent emergency admissions disturb elective surgical activities, resulting in decreasing efficiency and fewer elective procedures. We looked at the evidence of whether ring fencing elective surgery is an effective strategy to reduce disturbance from emergency activities, and improve the overall efficiency in hospitals with emergency as well as elective activities.


METHODS
We systematically searched for published studies that have addressed the above mentioned issues.


RESULTS
Approximately 10-17% of elective surgical operations are cancelled. In a Norwegian study, about 14% of cancellations seem to be caused by interference from emergency admissions. We did not find any empirical evidence on the effects of ring fencing elective surgery.


CONCLUSIONS
The belief that ring fencing is an effective strategy to decrease cancellations and increase hospital efficiency seems to be anchored in a priori reasoning rather than in published evidence.
Aaserud
M
M
Avdeling for samfunnsmedisin Statens institutt for folkehelse Postboks 4404 Nydalen 0403 Oslo. morten.aaserud@folkehelsa.no
Trommald
M
M
Boynton
J
J
D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004630:Emergencies; D006801:Humans; D008485:Medical Audit; D010343:Patient Admission / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data