Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years

Ulla Caesar, Jon Karlsson, Elisabeth Hansson
2018 Patient Safety in Surgery  
Extended waiting times, over-booked waiting lists and cancelled and delayed surgical procedures are realities for some patients treated at orthopaedic clinics in Sweden. This situation affects the prioritisation procedures for both emergency and elective surgery and results in even longer waiting lists, not only for planned patients but also for emergencies. Cancellations and delays are reported to be common and it is therefore important to study how to prevent them and also to understand how
more » ... ncellations and delays are experienced by patients. Method: Studies I and III were retrospective, observational, single-centre studies with data collected from the hospital's registers. The aim was to evaluate and describe the number of and reasons for delays and cancellations, as well as waiting times. Study I comprised 17,625 elective patients over a period of five years, while Study III comprised 36,017 emergency patients over seven years. Study II was qualitative and the aim was to elucidate the meaning of the lived experiences of patients after having hip or knee replacement surgery cancelled. The interviews were interpreted in three steps using a phenomenological hermeneutic analysis, which consists of a lifeworld perspective. In Study IV, the objective was systematically to search and review the literature for evidence of factors that might be used to reduce cancellations of and delays to orthopaedic procedures. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the Cochrane Handbook and the SBU handbook (Swedish Agency for Health Technology Assessment and Assessment of Social Services). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence in the included studies. This thesis is based on the following studies, referred to in the text by their Roman numerals. I Caesar U, Karlsson J, Olsson LE, Samuelsson K, Hansson-Olofsson E: Incidence and root causes of cancellations for elective orthopaedic procedures: a single centre experience of 17,625 consecutive cases. Patient Safety in Surgery 2014, 8:24. II Caesar U, Hansson-Olofsson E, Olsson L-E, Karlsson J, Lidén E. A sense of being rejected: patients' lived experiences of cancelled knee or hip replacement surgery Submitted III Caesar U, Karlsson J, Hansson E. Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.
doi:10.1186/s13037-018-0149-1 pmid:29344088 pmcid:PMC5763611 fatcat:gly2scimvneonjdiqclreihwce