Introduction: Operating rooms play a significant role in hospital operations as a major source of resource utilization and financial payout. Published data OR costs range from $10-20/min or up to $600/hr. Surgeries are major contributors to hospital revenue, especially profitable specialties such as neurosurgery. Unanticipated surgical cancellations are costly and pose a significant threat to efficiency of the operating day. Underprepared patients account for 2.1-5.3% of surgical cancellations and are potentially avoidable. We present data on pre-formulated preoperative checklists on reducing surgical cancellations.

Methods: We implemented a preoperative checklist in January 2013. Before that time period handwritten preoperative notes were typically written in charts. All inpatient and outpatient neurosurgical procedures were collected using our electronic medical system in 2012 and 2013. Cancellations were identified and reasons for cancellations were tabulated with stratification into preventable, nonpreventable, and unknown causes in addition to outpatient vs. inpatient procedure.

Results: A total of 3485 cases were collected; 1782 in 2012 and 1703 in 2013. The total cancellation rate in 2012 and 2013 was 2.13% (38) and 1.82% (31), respectively. Of all cancellations Inpatient preventative cancellations decreased from 29% to 13% with implementation of the preoperative checklist. Unpreventable cases increased from 0% to 19% during the two year period. Outpatient cancellations accounted for 55% and 52% of cancellations in 2012 and 2013, respectively.

Conclusions: A preoperative checklist for inpatient procedures appears to have a benefit on reducing preventable surgical cancellations. Although the absolute number of preventable cancellations may be small, when broadened to multiple subspecialties over many years, a substantial amount of lost income could be generated and operating room efficiency improved.

Patient Care: It will help hospitals and physicians save costs to reduce the overall healthcare cost burden and improve efficiency of patient care.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the importance of surgical cancellations to a hospitals revenue and resources. 2) Implementation of preoperative checklists can be a simple yet effective method in reducing surgical cancellations.

References: 1. Weinbroum, A.A., P. Ekstein, and T. Ezri, Efficiency of the operating room suite. Am J Surg, 2003. 185(3): p. 244-50. 2. Resnick, A.S., et al., Surgeon contribution to hospital bottom line: not all are created equal. Ann Surg, 2005. 242(4): p. 530-7; discussion 537-9. 3. Kumar, R. and R. Gandhi, Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. J Anaesthesiol Clin Pharmacol, 2012. 28(1): p. 66-9. 4. Schofield, W.N., et al., Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust, 2005. 182(12): p. 612-5.