Decreasing Same-Day Cancellations in an Interventional Pain Management Practice Improves Patient Care and Productivity

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In an interventional pain management practice, scheduling errors can increase the risk of procedural complications and often necessitate provider-initiated same-day procedure cancellations. To reduce the number of scheduling errors in the interventional pain management division of an orthopedic practice while simultaneously increasing the sites of service, a quality improvement project was initiated. The quality improvement plan consisted of instituting PDSA cycles of error data collection and workflow interventions. A quasi-experimental observational study, utilizing an interrupted time series design to assess the effects of interventions was implemented to reduce scheduling errors and same-day cancellations. For the time periods observed, total errors decreased by 57% between Q1 2019 and Q1 2020 (190 to 81) with the error rate decreasing 59% from 6.4% to 2.6% of patients scheduled (p-value = 8.8×10E -13). Total Q1 procedure cancellations decreased by 38% (100 to 62) with the cancellation rate decreasing 41% from 3.4% to 2.0% of patients scheduled (p-value = 9.24×10E -4). These decreases were found to be statistically significant. Though the overall rate of errors and cancellations decreased, some error categories increased between the two time periods observed. Cancellations due to active infections increased from 0 to 8 incidents, anticoagulants and NSAIDs not being held increased by11.9% and 18.9% respectively, and lack of necessary imaging increased by10.2%. This study demonstrated that though the interventions were successful at decreasing the overall scheduling errors and cancellation rates, more investigation should be conducted to identify additional factors contributing to scheduling errors and same-day cancellations along with effective interventions to address these factors.



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