title: Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.
abstract: BACKGROUND
  This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system.
  
  
  METHODS
  CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities.
  
  
  RESULTS
  Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive.
  
  
  CONCLUSIONS
  Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Medical Center, Birmingham, AL, USA.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Argo
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Vick
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bishop
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D003625:Data Collection; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*