The impact of a structured preoperative protocol on day of surgery cancellations

• Published in: Journal of clinical nursing 2018-01, Vol.27 (1-2), p.288-305
• Main Authors: Turunen, Elina, Miettinen, Merja, Setälä, Leena, Vehviläinen‐Julkunen, Katri
• Format: Article
• Language: English
• Subjects: Cancellations; care process; care structure; Nursing; operative pathway; Patient care planning; Patient compliance; Patient education; preoperative nurse; preoperative protocol; Protocol; Surgery; surgery cancellations
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.13896

Aims and objectives To evaluate the impact of implementing an evidence‐based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties. Background Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care. Design Observational study with two study phases: before and after. Methods The cancellation data were collected from the hospital register from 1 September 2013–31 May 2014 (n = 591) and from September 2015–May 2016 (n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically. Results Cancellation rates varied between 1.6%–9.7% (in the first phase) and between 1.5%–7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found. Conclusions A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates. Relevance to clinical practice An evidence‐based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high‐quality care for surgical patients.