Reducing cancelation rate of planned elective interventional pain procedure at NCCCR Cancer Pain Management Department : Qatar Background/Purpose Cancellations are a source of inconvenience, distress and frustration to both clinician and patient; it’s also, a waste of hospital time and resources, and lead to an increase in waiting lists (1). Elective interventional cases cancellation refers to any interventional procedure case that is booked into the operation theatre list on the day prior to procedure, but is canceled on scheduled day. The reasons for cancellation of elective surgical cases are many; they are as unique as they are similar. In this small audit we set out to identify these reasons and thereby develop a simple intervention to reduce the number of cancellations. Methods 1-Study design an setting -This is a prospective observational hospital based audit done between 1st January 2016 and 30 December, 2016. The audit was conducted in a 88 beds in oncology hospital with one operation theatre (OT) which provide elective surgical to cancer patients. The audit included all those patients who were posted for elective interventional procedure over a period of one year. Cancelled cases were identified from predesigned OT utilization formats and the reasons for cancellation were assessed through an audit tool which was developed by pain team. In this small audit we set out to identify these reasons of cancelation and thereby develop a simple intervention to reduce the number of cancellations. The initial audit done for the first six months (January to June, 2016 ) and the second audit conducted after intervention (from July to December, 2016) .it’s indeed for quality improvement analysis that we applied the" audit technique" based on triple steps (Review -Intervention- Evaluation). 2-Using audit and feedback to health professionals to improve the qualityand safety of health care Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact. Results Goals / Objectives The goal of this small audit was; 1- To identify the reasons of cancelation 2- To develop appropriate intervention in order to reduce the rate of cancelation 3-To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback. Audit Cycle Variables N % Gender Female 49 92% Male 27 8% Nationality Qatari 13 17% Non-Qatari 63 83% Age ≤ 40 year 36 47% > 40 year 40 53% Primary site of disease Hematology 60 79% Oncology 16 21% Type of Procedure at NCCCR MBB Diagnostic 19 29% Sacroiliac joint injections 8 12% Nerve Root diagnostic 1 2% Caudal epidural 4 6% Suprascapular nerve block+ Acromioclavicular joint injection 14 22% Ultrasound Guided Injection 2 3% Stellate ganglion block 2 3% Acromio-Clavicular Joint Injections 1 2% Steroid injections 3 5% Greater occipital nerve block 2 3% Impar gangelion injection 8 12% Infraorbital nerve block 1 2% Current Year: 2016 Analysis/Action: Jan-16 Analysis/Findings: one procedure from 2 was cancelled. 1/2 Action Plan: to analyze the data and identify the cause. 50% Feb-16 Analysis/Findings: 5 procedures from 10 were cancelled. 5/10 Action Plan: to analyze the data and identify the cause. 50% Mar-16 Analysis/Findings: one procedure from 9 was cancelled. 1/9 Action Plan: to analyze the data and identify the cause. 11% Apr-16 Analysis/Findings: 4 procedures from 7 were cancelled. 4/7 Action Plan: to analyze the data and identify the cause. 57% May-16 Analysis/Findings: 4 procedures from 10 were cancelled. 4/10 Action Plan: to analyze the data and identify the cause. 40% Jun-16 Analysis/Finding: 1 procedure from 7 were cancelled 1/7 14% Current Year: 2016 Analysis/Action: July 16 1/4 25% Analysis/Findings: one procedure from 4 was cancelled. Action Plan: to analyze the data and identify the cause. AUG 16 3/12 25% Analysis/Findings: 3 procedures from 12 were cancelled. Action Plan: to analyze the data and identify the cause. September 16 Analysis/Findings: one case was done no cancelation October 16 Analysis/Findings: one procedure done there was no cancelation November 16 1/4 25% Analysis/Findings: 1 procedure from 4 were cancelled. Action Plan: to analyze the data and identify the cause. Dec 16 Analysis/Finding:3 procedure done there was no cancelation • Physician spend long time explaining the procedure to patients • CNS introduced to see the patient at day care before procedure • Improve patient engagement by involving him/her more in care plan • The effective utilization of the call system services was reinforced. 35% 20% First semester 2016 Second semester 2016 Parameter first semster Second semester Number of Interventional procedures(N) 52 24 Procedures done (N) 36 19 Procedure cancelled (N) 16 5 50% 50% 11% 57% 30% 14% 67% 25% 0% 0% 25% 0% 0% 20% 40% 60% 80% 100% Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Percentage% Calendar Time (Months) Cancellation of booked elective pain procedure is a common problem across all hospitals in our country and around the world (1). The incidence of cancellation of elective procedure has been reported in literature to range from 20% to 40% [1,2,3]. This audit shows decrease cancelation by 15% after a minor intervention done by pain team. Conclusion Recommendation Pamphlet was developed by pain team and waiting for approval CNS clinic was established in order to provide adequate education and addressing patients’ concern. References 1. Chiu, C. H., Lee, A., & Chui, P. T. (2012). Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong Med J, 18(1), 5-10. 2.Narouze, S., Benzon, H. T., Provenzano, D. A., Buvanendran, A., De Andres, J., Deer, T. R., ... & Huntoon, M. A. (2015). Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the american society of regional anesthesia and pain medicine, the European society of regional anaesthesia and pain therapy, the american academy of pain medicine, the international neuromodulation society, the north american neuromodulation society, and the world institute of pain. Regional anesthesia and pain medicine, 40(3), 182-212. 3.Ojo E.O., Ihezue C.H (2008). An Audit of Day Case Cancellations In A Nigerian Tertiary Hospital Based Day Case Unit East and Central African Journal of Surgery; 13 (2); 150- 153. Team member : Ms. Khadra Yassin , Mr. Hafedh Ghazouani Dr. Ahmed Fayed Ahmed El Geziry , Dr. Wael Saleem Mr. Atef Mansour Mrawweh Al Tawafsheh, Ms. Mariamma Thomas