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Cancellation of Elective Surgery by the Hospital During the Admission

Basic Facts

Stage of development

Implemented

Potential or current usage

Use of this indicator would enable national comparison on continuity of care/ system performance and issues of capacity and patient experience. This measure is one of the NHS’ Key performance indicator targets.

Brief overview of the measure

General description

This measure was selected to provide information on the timeliness of surgery in hospital settings.

Rationale for selection

Cancellation of surgery once the patient is admitted will provide insight into the how close the system is running to capacity and is itself a measure of patient experience that is shown in other systems to be of importance to patients.

Type of measure

Process

Domain(s) of quality

Efficiency, People-centred

Application and interpretation of the measure

Stated intent of the measure

To investigate how close the system is running to capacity and to compare patient experience, continuity of care in hospital settings.

Caveats - Considerations

Hospital capacity requires close management. The expectation is that medical acute conditions would dominate during winter so that bed availability for surgical cases would diminish. Onset of epidemics may be relatively unpredictable so the overall value of this indicator may not be as expected by the expert group.

Target population

This indicator is inclusive of all age ranges, ethnicities and genders.

Stratification by vulnerable populations

If proxy available (i.e. query by quintile), then stratification by ethnicity or socio economic status may be of interest.

Calculation of the measure

Output of calculation

Percentage of surgeries that were cancelled after admission

Numerator description

Total number of cancelled surgeries

Numerator exclusions

Maternity surgeries.

Denominator description

Total number of patients discharged for at least one theatre session.

Denominator exclusions

Maternity surgeries.

Time period

Quarterly.

Data source

Numerator: NMDS (reliable data) Denominator: NDMS (NMDS is reasonably complete 3 months after the last day of the period)

Method of extraction

Numerator The definition of a cancelled operation in the wiesnz11 filter is: Cancelled Operations are tested for by checking that: The first operation/procedure code is blank AND That the event is non-acute (i.e. Admission Type not “AC”) AND Length of Stay is less than 2 days AND That one or more of the first six diagnosis codes contain the ICD-10-AM 6th Edition code for Persons encountering health services for specific procedures, not carried out, i.e. one (or more) of the diagnosis 1-6 is in the range Z530 – Z539: Z530 Procedure not carried out because of contraindication Z531 Procedure not carried out because of patient’s decision for reasons of belief or group pressure Z532 Procedure not carried out because of patient’s decision for other and unspecified reasons Z538 Procedure not carried out for other reasons Z539 Procedure not carried out, unspecified reason. Need to confirm, but would assume that a modified version of the above, focussing only on Z538 and Z539, would be appropriate. Denominator Total number of patients discharged following at least one theatre session indicated by the presence of at least two op codes, one of which indicating a GA

Appraisal of the measure

Availability of evidence to support application of the measure

A formal consensus procedure involving experts in relevant clinical and/or methodological sciences has been completed and documented., The measure has been developed or endorsed by an organization that promotes rigorous development and use of clinical performance measures (at an international, national, regional or local level).

Evidence of feasibility and reliability of implementation

Reliability - The measure has been demonstrated to be reliable (i.e. free from random error)., Interpretation - The measure allows unambiguous interpretation of better or worse performance., Data extraction - Data collection specifications for the measure are well defined., Data sources - Required data elements for the measure can be obtained from existing data sources., Availability of data - Required data elements for the measure can be gathered during routine practice activities, IT software - Existing IT software is sufficient for data collection.

Other items

Owner details

Reference number

595

Date of entry to library

2012-05-29 10:22:13

Owner (Organisation name)

Health Quality and Safety Commission, Indicators project team

Owner (Email contact)

richard.hamblin@hqsc.govt.nz

Creator (Organisation name)

Health Quality and Safety Commission: a version of this indicator is currently collected via Health Roundtable.

Creator (Email contact)

richard.hamblin@hqsc.govt.nz