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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

A new pathway for elective surgery to reduce cancellation rates

BMC Health Services Research > Ausgabe 1/2012
Einar Hovlid, Oddbjørn Bukve, Kjell Haug, Aslak Bjarne Aslaksen, Christian von Plessen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-154) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

EH had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. EH, OB, and KH conceived and designed the study. EH acquired the data. EH, CVP, and ABA analyzed and interpreted the data. EH, CVP, ABA, and KH drafted the manuscript. EH, CVP, OB, and KH critically revised the manuscript for important intellectual content. EH and CVP provided statistical expertise. OB and EH obtained funding. CVP, ABA, OB, and KH supervised the study. All authors read and approved the final manuscript.



The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery and explored which factors affected the outcomes.


We collected the number of planned operations, performed operations, and cancellations per month from the hospital’s patient administrative system. We then used Student's t-test to analyze differences in cancellation rates (CRs) before and after interventions and a u-chart to analyze whether the improvements were sustained. We also conducted semi-structured interviews with employees of the hospital to explore the changes in the surgical pathway and the factors that facilitated these changes.


The mean CR was reduced from 8.5% to 4.9% (95% CI for mean reduction 2.6-4.5, p < 0.001). The reduction in the CR was sustained over a period of 26 months after the interventions. The median number of operations performed per month increased by 17% (p = 0.04). A clear improvement strategy, involvement of frontline clinicians, introduction of an electronic scheduling system, and engagement of middle managers were important factors for the success of the interventions.


The redesign of the old clinical pathway contributed to a sustained reduction in cancellations and an increased number of performed operations.
Authors’ original file for figure 1
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