Hospital policy following cancelled orthopaedic surgery and the patient experience—making the best of a bad situation

Abdus Samee Wasim, Shafiq Shahban, Ved Goswami


Background: Number of cancelled electiveorthopaedic surgeries has increased over the last decade as strains on surgicalservices exacerbates. Being told an operation is cancelled is disappointing forthe patient, the clinician and is not without a financial loss. This experienceis frustrating for patients who are often not informed of cancellations bydoctors and sent home dissatisfied without clarity of treatment plans.Alternatives have to be sought to safeguard the patient experience, maintaincommunication and avoid wastage of resources.
Methods: Over a 1-year period, 117 patientswere prospectively shortlisted with a cancellation on the day of surgery in adedicated elective orthopaedic unit. Questionnaire data assessed adherence toAssociation of Anaesthetists of Great Britain and Ireland Theatre Efficiencyguidance, including: healthcare professional informing patients; time offeredfor explanation; patient understanding and satisfaction as well as perceptionof being kept nil by mouth (NBM) longer than necessary. Opinions of alternativesatisfactory professionals to lead cancellation discussion was also evaluated.
Results: 35.04% of cancellations were informedby consultants, 23.77% by junior doctors and 38.46% by nurses. Out of 10,patient understanding was 8.31 and satisfaction 6.37 for consultant leddiscussions against 5.12 and 4.07 for nurses, respectively. Overall, 35.04% ofpatients felt they were kept NBM longer than necessary vs. 60% of the 45patients told by nurses. 90.60% felt consultants were the ideal professional tolead cancellation discussions however 70.94% stated a registrar would besatisfactory.
Conclusions: Cancelledelective surgery that a patient has mentally prepared for is extremelydemoralising. Poor peri-operative communication and management further worsensthe patient experience and represents sub-standard care. It is paramount thatguidelines exist where patients are informed of reasons for cancellation by asenior surgeon in a manner that accounts for availability of resources.