title: Statistical process control for cancelled operations at the paediatric surgery department of a university hospital.
abstract: BACKGROUND
  Being a cause of delayed patient management and underutilization of resources, cancelled operations are considered a low quality service. Moreover, anticipation of surgery is stressful for both patients and families, particularly if the patient is a child; additional anxiety posed by last-minute cancellation is, therefore, of primary concern.
  
  
  OBJECTIVE
  The present study was done to estimate the rate and explore the determinant causes of cancellation of planned operations on the day of surgery at the paediatric surgery department of a university hospital in Alexandria.
  
  
  METHODS
  A cross sectional study was performed, interviewing some paediatric surgeons and anaesthesiologists practising at the hospital to collect in depth information about causes of cancelled operations, in addition to revising daily operation sheets for 181 operations to calculate cancellation rate and causes of cancelled operations. To Study patterns of variation in cancellation rate, a control chart (p-chart) was drawn.
  
  
  RESULTS
  The overall cancellation rate was almost 25%. Analysis of the control chart showed an average cancellation rate of 25%, upper control limit of 74% and a Lower control limit of zero. Of the cancelled operations, 64.4% were of avoidable causes. Pareto chart showed that not being fit for anaesthesia either for electrolyte disturbances, low haemoglobin level or fever was the commonest reason for cancellation of operation, followed by patient having chest infection and patient or doctors not showing on the day of operation (those formed more than 85% of causes).
  
  
  CONCLUSIONS
  Implementation of outpatient preoperative assessment and preparation for surgery, in addition to the improvement of communication between patient, doctors and nurses are highly recommended.
authors.affiliation: Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt. moatazamahmoud@yahoo.com.
authors.forename: Moataza M
authors.initials: MM
authors.lastname: Abdel Wahab
authors.forename: Nagwa Y
authors.initials: NY
authors.lastname: Abou El-Enein