Hospital Non-Clinical Cancelled Operations as % of Elective Operations
% of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or
on the day of operation
On the day non-clinical cancelled operations (elective)
Reason
Ward Bed Unavailable
ICU/HDU Bed Unavailable
Clinical Priority
Staffing
Theatre Time
Administrative Error
Equipment
Other
Apr-12
48
23
17
2
7
7
5
May-12
9
24
44
11
11
1
3
Jun-12
6
7
35
9
10
5
2
Jul-12
15
12
20
1
8
4
10
Aug-12
1
9
29
5
7
4
2
Sep-12
5
5
18
6
10
11
11
109
1.59%
12
0
0
103
1.22%
6
1
1
74
1.04%
2
0
0
70
0.87%
5
1
0
57
0.77%
3
0
0
66
0.95%
1
0
0
Reason
Feb-12(elective)
Mar-12
Apr-12
Prior to the day non-clinical cancelledJan-12
operations
Ward Bed Unavailable
ICU/HDU Bed Unavailable
Clinical Priority
Staffing
Validated reason breakdown is
Theatre Time
Administrative Error
only available from May 2012
Equipment
Other
Prior to the day Cancelled Operations
570
679
610
358
% of Operations cancelled (Prior to the day)
7.45%
9.21%
7.59%
5.21%
May-12
5
Jun-12
6
Aug-12
1
74
60
11
4
7
51
35
3
6
36
Sep-12
1
1
64
21
3
On the day Cancelled Operations
% of Operations cancelled (on the day)
Cancelled twice for the same procedure
Cancelled 3 times for the same procedure
Cancelled 4 times or more for the same procedure
Jan-12
123
14
14
12
10
1
5
2
181
2.37%
13
1
0
Feb-12
65
11
19
16
3
3
5
2
124
1.68%
11
3
0
Mar-12
54
32
22
23
9
3
5
1
149
1.85%
11
4
0
161
1.91%
137
1.93%
Jul-12
5
2
66
69
7
7
47
4
207
2.57%
60
28
7
10
18
1
125
1.68%
Oct-12
24
10
35
13
7
9
9
1
108
1.33%
6
1
0
Nov-12
11
18
29
5
6
5
4
Oct-12
Nov-12
1
1
69
40
3
7
78
1.03%
2
0
0
74
58
5
1
96
1.39%
120
1.48%
5
3
1
142
1.88%
Dec-12
8
10
15
11
4
3
3
1
55
0.88%
1
0
0
Jan-13
7
5
12
9
8
9
6
3
59
0.78%
3
0
0
Feb-13
7
12
26
2
7
8
4
Mar-13
10
4
24
9
10
3
2
Apr-13
2
3
28
2
8
8
5
2
58
0.77%
1
0
0
May-13
2
2
19
11
10
7
7
Jun-13
8
13
25
3
2
9
3
66
0.95%
1
0
0
62
0.83%
1
0
0
58
0.75%
1
0
0
63
0.87%
3
0
0
Dec-12
4
1
60
33
3
3
Feb-13
4
2
106
1.69%
Jan-13
3
1
58
48
19
4
9
3
145
1.92%
Apr-13
1
58
55
9
6
5
10
147
2.12%
Mar-13
2
3
64
44
7
8
1
1
130
1.74%
May-13
1
1
54
48
2
9
2
117
1.51%
Jun-13
2
2
67
31
6
4
3
7
122
1.69%
Jun-13
46
41
7
7
2
2
106
1.40%
Total non-clinical cancelled operations (elective)
Reason
Total Cancelled Operations
% of Operations cancelled (Total)
Jan-12
751
9.82%
Feb-12
803
10.90%
Mar-12
759
9.44%
Apr-12
467
6.79%
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
264
211
277
182
162
228
220
161
204
213
192
164
175
185
3.12%
2.97%
3.43%
2.45%
2.34%
2.81%
2.91%
2.57%
2.70%
3.08%
2.57%
2.17%
2.25%
2.56%
Jan-12
Feb-12
Mar-12
Apr-12
May-12
6
0
0
Jun-12
17
8
0
Jul-12
27
15
5
Aug-12
9
6
1
Sep-12
9
2
0
Oct-12
18
2
0
Nov-12
6
3
0
Dec-12
8
1
0
Jan-13
20
2
0
Feb-13
11
0
0
Mar-13
12
1
0
Apr-13
7
0
0
May-13
8
0
0
Jun-13
12
3
0
Cancelled prior to day
Cancelled twice for the same procedure
Cancelled 3 times for the same procedure
Cancelled 4 times or more for the same procedure
On the day non-clinical cancelled operations (elective)
Indicator
level
Standard
Latest
performance
YTD
Forecast
Signed off by:
Expected date to
meet standard:
Revised date to
meet standard
1
0.80%
0.87%
0.79%
Green
Jenny Leggott
TBC
-
Total non-clinical cancelled operations (elective)
Indicator
level
Standard
Latest
performance
YTD
Forecast
Signed off by:
Expected date to
meet standard:
Revised date to
meet standard
1
TBA
2.56%
2.32%
-
Jenny Leggott
TBC
-
0
Hospital Non-Clinical Cancelled Operations as % of Elective Operations
% of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or
on the day of operation
Total and On the Day Cancelled Operations
(as % of all operations)
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
% of O pe rations cance lle d ( T otal )
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
Mar-12
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Mar-11
Feb-11
Jan-11
0.0%
% of O pe rations cance lle d (on the day)
Issues causing underperformance
Agreed corrective actions (planned and commenced)
A total of 185 operations were cancelled of which 63 were cancelled on the day of
admission – this equates in total to 2.55 % of elective admissions. In the same
period 7,233 elective procedures were undertaken at NUH.
Work continues to be done to reduce the level of both on and prior to the day
cancellations at NUH and to sustain the reduction we achieved in 12/13. However,
further work is required to reduce to a level below target and this will focus at
individual specialty and operating list level.
The main reason for on the day cancellations in June was clinical priority. This
includes patients cancelled to accommodate emergency cases and list overruns
due to other patients developing complications and taking more theatre time than
planned. There was also a higher than usual number of cancellations due to ward
and critical care bed availability which is associated with pressure on emergency
surgical capacity in June. This has not been replicated in July to date.
Three patients were cancelled for the second time on the day in June due to a
combination of previous patient complications in theatre, insufficient critical care
capacity and a supply issue of a specific drug required for an operation. Two of the
patients have had treatment and a further patient is dated in July.
The 15 patients cancelled more than once, including prior to the day, were mostly
rescheduled to accommodate more clinically urgent or cancer patients.
A Project Manager has been appointed to lead this further work and came into
post in July. The Project Manager is working closely with Theatre teams to set up
an RCA (root cause analysis) process to understand better to underlying causes of
cancellation on the day. An early focus will be to identify ways in which specialties
can work differently to reduce the likelihood of patients being rescheduled prior to
the day.
In the meantime, work continues to roll-out an improved theatre scheduling
process alongside the right sized theatre timetable. Better for You improvement
work in Sterile Services is ongoing.
The drug supply issue which caused the second on the day cancellation has been
addressed and additional processes have been put in place in both Pharmacy and
Neurosurgery to ensure that the issue cannot reoccur.
1