Cancelled Operations

This topic seems to be around a lot at the moment, with the BBC running a story on cancelled cancer operations. Moreover this point being very well explored, again by the BBC, in their show Hospital (a program I encourage all of you to watch!) I wanted to put our perspective across.

I work primarily in the cardiac catheter lab, and cancelled operations are a regular part of our job, and this can happen for numerous reason.
The catheter lab schedules tend to be a mix of planned elective cases, inpatients and emergencies. Generally the emphasis is on getting all elective work booked that day done, then inpatients to help clear the wards. However we can never plan for the emergencies that come through the door, and for us those are patients who are currently having a heart attack (STEMI), and require immediate emergency care – and yes we do have targets to meet even on these, timed from initial activation of the STEMI to the first Device time in the lab – every second counts in these situations.

To give you an idea of our day in the lab, and this is most typical for a tertiary centre – (and was a recent day for me!)

This particular day we had 6 elective day cases booked into my lab. We started the day (9am) with our first diagnostic patient, mid way through this the STEMI alert was activated, the lab finished the elective patient and turned around to accept the emergency. This procedure was reasonably straight forward, we finished within an hour and sent for our next elective patient. Again the STEMI alert was activated, followed closely by a second. The first was a patient in RESUS and was brought directly into the lab – yes we had to take the elective back to the day unit.
By the end of the second emergency it was 11:30am and we had a further STEMI waiting in A+E. This patient as it was slightly more complex took us until 1:30pm.
Due to staffing levels the lab had to be stopped to allow a lunch break. 15mins into this lunch break we were activated by the registrar as the first STEMI was acutely unwell. This patient then required ventilation and full anesthetic involvement, this ultimately meant they required an ITU bed, however one was not available. This is not unusual and often means we have to keep the patient with us in the catheter lab, until one is ready. In this case it was about an hour. That’s an hour we can not use this lab.
So now it’s 16:00pm the staff have finally had the rest of their lunch break. However our labs close at 5pm to elective work, which meant out of the 5 remaining elective cases we could only safely do one, and the rest had to be cancelled.
Understandably there were some complaints from those patients. And yes we know its highly stressful and upsetting to have your procedure cancelled, but unfortunately sometimes it’s necessary and completely out of our control, so please do not take your frustrations out on us.

Just to compare – the following day we had no STEMI alerts and managed all Elective work plus 3 in patient – We can not plan for these emergencies.

The other issue you would have heard of recently, is “black” or “red” alerts. This is when there is no free bed capacity in the hospital including ITU. This means long waits for beds in A+E, as there is no flow through the hospital. At this point we have to work very hard to get inpatient work done so we can free up beds and relieve pressure on the hospital.

We never want to cancel operations, but sometimes there is no other option.

CP

 

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