Cancellations within 24 h of planned elective surgical procedures reduce operating theatre efficiency, add unnecessary costs and negatively affect patient experience. We implemented a bundle intervention that aimed to reduce same-day case cancellations. This consisted of communication tools to improve patient engagement and new screening instruments (automated estimation of ASA physical status and case cancellation risk score plus four screening questions) to identify patients in advance (ideally before case booking) who needed comprehensive pre-operative risk stratification. We studied patients scheduled for ambulatory surgery with the otorhinolaryngology service at a single centre from April 2021 to December 2022. Multivariable logistic regression and interrupted time-series analyses were used to analyse the effects of this intervention on case cancellations within 24 h and costs. We analysed 1548 consecutive scheduled cases. Cancellation within 24 h occurred in 114 of 929 (12.3%) cases pre-intervention and 52 of 619 (8.4%) cases post-intervention. The cancellation rate decreased by 2.7% (95%CI 1.6–3.7%, p < 0.01) during the first month, followed by a monthly decrease of 0.2% (95%CI 0.1–0.4%, p < 0.01). This resulted in an estimated $150,200 (£118,755; €138,370) or 35.3% cost saving (p < 0.01). Median (IQR [range]) number of days between case scheduling and day of surgery decreased from 34 (21–61 [0–288]) pre-intervention to 31 (20–51 [1–250]) post-intervention (p < 0.01). Patient engagement via the electronic health record patient portal or text messaging increased from 75.9% at baseline to 90.8% (p < 0.01) post-intervention. The primary reason for case cancellation was patients' missed appointment on the day of surgery, which decreased from 7.2% pre-intervention to 4.5% post-intervention (p = 0.03). An anaesthetist-driven, clinical informatics-based bundle intervention decreases same-day case cancellation rate and associated costs in patients scheduled for ambulatory otorhinolaryngology surgery.

中文翻译：

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门诊耳鼻喉科手术的捆绑干预对当日病例取消率和相关成本的影响

在 24 小时内取消计划的择期手术会降低手术室效率，增加不必要的成本并对患者体验产生负面影响。我们实施了捆绑干预措施，旨在减少当日案件取消。其中包括提高患者参与度的沟通工具和新的筛查工具（自动估计 ASA 身体状况和病例取消风险评分以及四个筛查问题），以提前识别需要全面术前风险分层的患者（最好是在病例预约之前）。我们研究了 2021 年 4 月至 2022 年 12 月在单一中心计划接受耳鼻喉科门诊手术的患者。使用多变量逻辑回归和间断时间序列分析来分析这种干预措施对 24 小时内取消病例和成本的影响。我们分析了 1548 个连续的预定案例。干预前 929 例中有 114 例（12.3%）在 24 小时内取消，干预后 619 例中有 52 例（8.4%）在 24 小时内取消。第一个月取消率下降了 2.7% (95%CI 1.6–3.7%, p < 0.01)，随后每月下降 0.2% (95%CI 0.1–0.4%, p < 0.01)。预计成本节省 150,200 美元（118,755 英镑；138,370 欧元）或 35.3%（p < 0.01）。病例安排和手术日之间的中位天数（IQR [范围]）从干预前的 34 天（21-61 [0-288]）减少到干预后的 31 天（20-51 [1-250]）（p < 0.01）。通过电子健康记录患者门户或短信进行的患者参与度从基线时的 75.9% 增加到干预后的 90.8% (p < 0.01)。病例取消的主要原因是患者手术当天错过预约，这一比例从干预前的 7.2% 下降到干预后的 4.5% (p = 0.03)。由麻醉师驱动、基于临床信息学的集束干预可降低计划进行门诊耳鼻喉科手术的患者的当日病例取消率和相关费用。