Abstract

It was noted that a number of patients were having their procedures cancelled on the day of surgery because their antiplatelet or anticoagulative medications had not been stopped preoperatively. The team recognised that this problem was leading to an unnecessary waste of the department‘s labour and financial resources, and more importantly was becoming a source of disappointment and anxiety to patients.

A retrospective analysis of all plastic surgery cases was performed for procedures listed for the previous 12 months. All cancellations and the reasons for them were recorded, which came to 23 cases. The sum of the financial tariffs for each cancelled procedure was calculated to assess the financial impact of the identified problem: £20,000. A root cause analysis was performed to assess where this problem was arising in the patient’s preoperative journey. The common theme was the lack of information for the gatekeeper regarding the patients' anticoagulant and antiplatelet medications.

A new gatekeeper form was introduced to practice with a subsection specifically highlighting antiplatelet and anticoagulative medications. In addition, this issue was highlighted to the relevant staff in the department.

After four months, a second PDSA cycle was performed in the same manner. Seven cases were cancelled due to anticoagulants or antiplatelets not being stopped prior to surgery. This equated to a net loss of £11,865 to the department when projected over 12 months, improving on the performance prior to the newly introduced changes.