title: Reducing Cancelations on the Day of Scheduled Surgery at a Children's Hospital.
abstract: OBJECTIVE
  Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation.
  
  
  METHODS
  Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods.
  
  
  RESULTS
  Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites.
  
  
  CONCLUSIONS
  By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization.
authors: Departments of Anesthesiology and Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; and jayant.pratap@cchmc.org.
authors: Jayant Nick
authors: JN
authors: Pratap
authors: Departments of Anesthesiology and Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; and.
authors: Anna M
authors: AM
authors: Varughese
authors: Same Day Surgery.
authors: Patti
authors: P
authors: Mercurio
authors: Same Day Surgery.
authors: Terri
authors: T
authors: Lynch
authors: Ambulatory Services and.
authors: Teresa
authors: T
authors: Lonnemann
authors: Same Day Surgery.
authors: Andrea
authors: A
authors: Ellis
authors: Perioperative Administration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: John
authors: J
authors: Rugg
authors: Perioperative Administration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: W Ray
authors: WR
authors: Stone
authors: Perioperative Administration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Cindi
authors: C
authors: Bedinghaus
mesh_terms: D001071:Appointments and Schedules; D002648:Child; D006776:Hospitals, Pediatric; D006801:Humans; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*
keywords: child; operating rooms; quality improvement