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Pediatric Radiology

, Volume 45, Issue 1, pp 99–107 | Cite as

Factors impacting same-day cancellation of outpatient pediatric magnetic resonance imaging under anesthesia

  • Andrea S. HoffmanEmail author
  • Anne Matlow
  • Manohar Shroff
  • Eyal Cohen
Original Article

Abstract

Background

Studies of elective surgical procedures indicate that cancellation is common and preventable. Little is known about cancellation of anesthesia-supported elective diagnostic imaging.

Objective

To describe the reasons for same-day cancellation of MRI studies performed under sedation or anesthesia and identify patient characteristics associated with cancellations.

Materials and methods

This case–control study was carried out in a university-affiliated tertiary care children’s hospital. Cases were defined as elective outpatient MRI studies booked under anesthesia that were cancelled after the patient had arrived in the radiology department in 2009. Matched controls were identified by selecting the same day and time 1 week before or after the cancelled case. Main outcome measures included demographics, MRI study characteristics, and social and medical factors.

Results

There were 111 outpatient anesthesia-supported MRI studies cancelled on the same day as the assessment (cancellation rate: 4.5%), of which 74.6% were related to family and patient factors, while 22% were related to system factors. Cancelled cases involved patients who lived in lower median income quintile neighborhoods compared to controls (2 vs. 3; P = 0.0007; odds ratio [OR] 3.81; 95% confidence interval [CI] 1.18-12.34). Those who traveled a greater median distance (in kilometers) were less likely to be cancelled (18.8 vs. 27.1, P = 0.0035). Although cancelled patients had a lower mean number of total medical services (2.5 vs. 3.0; P = 0.03; OR = 0.78; 95% CI 0.62-0.98), current medical factors (past 12 months) did not impact cancellations.

Conclusion

Same-day cancellations of anesthesia-supported MRI studies are not uncommon, and the main predictor of cancellation seems to be socioeconomic rather than medical.

Keywords

Magnetic resonance imaging Scheduling Anesthesia Socioeconomic factors Complex chronic conditions Children Adolescents 

Notes

Acknowledgments

We thank Albert Aziza for his help accessing the MRI database, Maxie Richman and Inam Elahi for their help with data acquisition and Kelvin Lam for providing programming and statistical support for this project. This work was supported by the University of Toronto Centre for Patient Safety, SickKids site.

Conflicts of interest

None

References

  1. 1.
    Mantoni MY (2006) Waste of resources as a result of cancelled or delayed diagnostic imaging of hospitalized patients. Ugeskr Laeger 168:3125–3128PubMedGoogle Scholar
  2. 2.
    Benson S (1994) Improving patient care in MRI. Radiol Manag 16:30–31Google Scholar
  3. 3.
    Kuhn SA, Stuyvesant KE (1995) Quality improvements through direct patient pretest communication. J Nucl Med Technol 23:91–92Google Scholar
  4. 4.
    Recht M, Macari M, Lawson K et al (2013) Impacting key performance indicators in an academic MR imaging department through process improvement. J Am Coll Radiol 10:202–206PubMedCrossRefGoogle Scholar
  5. 5.
    Macarthur AJ, Macarthur C, Bevan JC (1995) Determinants of pediatric day surgery cancellation. J Clin Epidemiol 48:485–489PubMedCrossRefGoogle Scholar
  6. 6.
    Chamisa I (2008) Why is surgery cancelled? A retrospective evaluation. S Afr J Surg 46:79–81PubMedGoogle Scholar
  7. 7.
    Schofield WN, Rubin GL, Piza M et al (2005) Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust 182:612–615PubMedGoogle Scholar
  8. 8.
    Tait AR, Voepel-Lewis T, Munro HM et al (1997) Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth 9:213–219PubMedCrossRefGoogle Scholar
  9. 9.
    Schedule of Benefits for Physician Services under the Health Insurance Act. Ministry of Health and Long-Term Care. http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html. Accessed 1 April 2014
  10. 10.
    Mustard CA, Derksen S, Berthelot JM et al (1999) Assessing ecologic proxies for household income: a comparison of household and neighbourhood level income measures in the study of population health status. Health Place 5:157–171PubMedCrossRefGoogle Scholar
  11. 11.
    Kozyrskyj AL, Dahl ME, Chateau DG et al (2004) Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics. CMAJ 171:139–145PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Kozyrskyj AL, Mustard CA, Simons FE (2001) Socioeconomic status, drug insurance benefits, and new prescriptions for inhaled corticosteroids in schoolchildren with asthma. Arch Pediatr Adolesc Med 155:1219–1224PubMedCrossRefGoogle Scholar
  13. 13.
    Wang C, Guttmann A, To T et al (2009) Neighborhood income and health outcomes in infants: how do those with complex chronic conditions fare? Arch Pediatr Adolesc Med 163:608–615PubMedCrossRefGoogle Scholar
  14. 14.
    Feudtner C, Christakis DA, Connell FA (2000) Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997. Pediatrics 106:205–209PubMedGoogle Scholar
  15. 15.
    Cohen E, Berry JG, Camacho X et al (2012) Patterns and cost of health care use of children with medical complexity. Pediatrics 130:1–8CrossRefGoogle Scholar
  16. 16.
    Srivastava R, Downey EC, Feola P et al (2007) Quality of life of children with neurological impairment who receive a fundoplication for gastroesophageal reflux disease. J Hosp Med 2:165–173PubMedCrossRefGoogle Scholar
  17. 17.
    Rosenbaum P (2008) Report of the Paediatric Complex Care Coordination Expert Panel. http://www.sickkids.ca/pdfs/Paediatric-Medicine/34603-PCCC%20Expert%20Panel%20Report.pdf. Accessed 1 April 2014
  18. 18.
    U.S. Congress, Office of Technology Assessment (1987) Technology-Dependent Children: Hospital v. Home care — A Technical Memorandum, OTA-TM-H-38. U.S. Government Printing Office, Washington, D.C. http://www.princeton.edu/~ota/disk2/1987/8728/872801.PDF. Accessed 1 April 2014
  19. 19.
    Johnson GG (1983) Day care surgery for infants and children. Can Anaesth Soc J 30:553–557PubMedCrossRefGoogle Scholar
  20. 20.
    Postuma R, Ferguson CC, Stanwick RS et al (1987) Pediatric day-care surgery: a 30-year hospital experience. J Pediatr Surg 22:304–307PubMedCrossRefGoogle Scholar
  21. 21.
    Kleinfeldt AS (1990) Preoperative phone calls. Reducing cancellations in pediatric day surgery. AORN J 51:1559–1564PubMedCrossRefGoogle Scholar
  22. 22.
    Kroovand RL, Perlmutter AD (1978) Short stay surgery in pediatric urology. J Urol 120:483–484PubMedGoogle Scholar
  23. 23.
    Patel RI, Hannallah RS (1992) Preoperative screening for pediatric ambulatory surgery: evaluation of a telephone questionnaire method. Anesth Analg 75:258–261PubMedGoogle Scholar
  24. 24.
    Haana V, Sethuraman K, Stephens L et al (2009) Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J Surg 79:636–640PubMedCrossRefGoogle Scholar
  25. 25.
    Chiu CH, Lee A, Chui PT (2012) Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong Med J 18:5–10PubMedGoogle Scholar
  26. 26.
    Garg R, Bhalotra AR, Bhadoria P et al (2009) Reasons for cancellation of cases on the day of surgery-a prospective study. Indian J Anaesth 53:35–39PubMedCentralPubMedGoogle Scholar
  27. 27.
    Séguin L, Xu Q, Potvin L et al (2003) Effects of low income on infant health. CMAJ 168:1533–1538PubMedCentralPubMedGoogle Scholar
  28. 28.
    Wilkins R, Berthelot J-M, Ng E (2002) Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Health Reports pp 1–28Google Scholar
  29. 29.
    Canada S (1999) Health status of children. Health Reports, pp 25–34Google Scholar
  30. 30.
    Brownell M, Martens P, Kozyrskyj A et al. (2001) Assessing the health of children in Manitoba: a population-based study. Manitoba Centre for Health Policy and Evaluation, Winnipeg, Manitoba, Canada. http://mchp-appserv.cpe.umanitoba.ca/reference/child_pdf_one_document.pdf. Accessed 1 April 2014
  31. 31.
    Luo ZC, Kierans WJ, Wilkins R et al (2004) Disparities in birth outcomes by neighborhood income: temporal trends in rural and urban areas, british columbia. Epidemiology 15:679–686PubMedCrossRefGoogle Scholar
  32. 32.
    Luo ZC, Wilkins R, Kramer MS et al (2006) Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ 174:1415–1420PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Martens PJ, Derksen S, Gupta S (2004) Predictors of hospital readmission of Manitoba newborns within six weeks postbirth discharge: a population-based study. Pediatrics 114:708–713PubMedCrossRefGoogle Scholar
  34. 34.
    Kozyrskyj AL, Hildes-Ripstein GE (2002) Assessing health status in Manitoba children: acute and chronic conditions. Can J Public Health 93:S44–49PubMedGoogle Scholar
  35. 35.
    Harrison RL, Li J, Pearce K et al (2003) The community dental facilitator project: reducing barriers to dental care. J Public Health Dent 63:126–128PubMedCrossRefGoogle Scholar
  36. 36.
    McClure RJ, Newell SJ, Edwards S (1996) Patient characteristics affecting attendance at general outpatient clinics. Arch Dis Child 74:121–125PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Mikkonen J, Raphael D (2010) Social determinants of health: the Canadian facts. York University School of Health Policy and Management, TorontoGoogle Scholar
  38. 38.
    Marmot M (2002) The influence of income on health: views of an epidemiologist. Health Aff (Millwood) 21:31–46CrossRefGoogle Scholar
  39. 39.
    Rogowski J, Freedman VA, Wickstrom SL et al (2008) Socioeconomic disparities in medical provider visits among medicare managed care enrollees. Inquiry 45:112–129PubMedGoogle Scholar
  40. 40.
    Ruijsbroek A, Wijga AH, Kerkhof M et al (2011) The development of socio-economic health differences in childhood: results of the Dutch longitudinal PIAMA birth cohort. BMC Public Health 11:225PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Lowcock EC, Rosella LC, Foisy J et al (2012) The social determinants of health and pandemic H1N1 2009 influenza severity. Am J Public Health 102:e51–e58PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Yin HS, Johnson M, Mendelsohn AL et al (2009) The health literacy of parents in the United States: a nationally representative study. Pediatrics 124:S289–S298PubMedCrossRefGoogle Scholar
  43. 43.
    Ratzan SC, Parker RM (2000) Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM (eds) National Library of Medicine Current Bibliographies in Medicine: Health Literacy. In: National Institutes of Health, US Department of Health and Human Services, Bethesda, MDGoogle Scholar
  44. 44.
    Abrams MA, Klass P, Dreyer BP (2009) Health literacy and children: recommendations for action. Pediatrics 124:S327–331PubMedCrossRefGoogle Scholar
  45. 45.
    Langley GJ (1996) The improvement guide: a practical approach to enhancing organizational performance. Jossey-Bass Publishers, San FranciscoGoogle Scholar
  46. 46.
    Statistics Canada Library (2012) Toronto, Ontario (Code 3520005) and Ontario (Code 35). Census Profile. 2011 Census. In: Canada S (ed). Statistics Canada Catalogue no. 98-316-XWE., Ottawa, Ontario, CanadaGoogle Scholar
  47. 47.
    McPherson M, Arango P, Fox H et al (1998) A new definition of children with special health care needs. Pediatrics 102:137–140PubMedCrossRefGoogle Scholar
  48. 48.
    Newacheck PW, Strickland B, Shonkoff JP et al (1998) An epidemiologic profile of children with special health care needs. Pediatrics 102:117–123PubMedCrossRefGoogle Scholar
  49. 49.
    Association CPH (1997) Health impacts of social and economic conditions: implications for public policy. Board of directors discussion paper. Canadian Public Health Association, Ottawa, Ontario, CanadaGoogle Scholar
  50. 50.
    Tugwell P, Kristjansson B (2004) Moving from description to action: challenges in researching socio-economic inequalities in health. Can J Public Health 95:85–89PubMedGoogle Scholar
  51. 51.
    Veugelers PJ, Yip AM, Kephart G (2001) Proximate and contextual socioeconomic determinants of mortality: multilevel approaches in a setting with universal health care coverage. Am J Epidemiol 154:725–732PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Andrea S. Hoffman
    • 1
    Email author
  • Anne Matlow
    • 2
  • Manohar Shroff
    • 3
  • Eyal Cohen
    • 4
  1. 1.Department of Paediatrics, Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation HospitalUniversity of TorontoTorontoCanada
  2. 2.Strategic Initiatives, Postgraduate Medical EducationUniversity of TorontoTorontoCanada
  3. 3.Department of Diagnostic Imaging, Division of Neuroradiology, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  4. 4.Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Department of Paediatrics and Institute of Health Policy, Management & EvaluationUniversity of TorontoTorontoCanada

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