A Cross-Sectional (Both Qualitative and Quantitative) Study on Factors Impacting Surgical Patient Waiting Times and Cancellation of Theatre Lists in Malawi District and Rural Hospitals: A Case Study of Nkhotakota District Hospital

Abstract

Chimwemwe Kana*, Sue Chichlowska and Wingston Ngambi

Introduction: Surgical case cancellation is defined as canceling planned surgery after the patient has been notified of the operation date, on the day of or the day preceding surgery. Surgical patient waiting time is the time from when the patient is admitted to the hospital for a surgical procedure to the day of the operation. Cancellation of scheduled surgery specifically in Africa creates a financial burden for hospitals, caregivers, and patients. It causes emotional stress, which impacts outcomes. In poor countries where the adequacy of health care is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important and worthy of investigation.

Objective of study: An investigation of the main factors that lead to surgical patients’ waiting times and cancellation of theatre lists in the district and rural hospitals of Malawi. This study was conducted at Nkhotakota District Hospital in the central region of Malawi. The hospital serves a catchment area of 379,474 people with a bed capacity of 300.

Methods: This was a cross-sectional study in which both retrospective and prospective data were collected using theatre, ward, and surgical booking registers. Surgical staff, including nurses, clinicians, anesthetists, and administrative personnel, were interviewed.

Results: During the study period (6 months), 240 patients (93 females and 147 males) were booked for surgery. A total of 118 patients were operated on, representing 49%, and 122 patients were canceled, representing 51%. The cancellation rate was highest for general surgery (60%), gynecology (25%) and other cases (15%). There were no cancellations for orthopedic cases. Regarding the waiting time before the procedure, it was found that surgical patients on average waited for 2 days to be operated on or for a procedure to be cancelled.

Conclusion: The main reasons for theater cancellation found in this study were avoidable. Reasons such as inadequate surgical staff, lack of motivation for surgical staff by hospital management and patients not turning up on the day of surgery could be overcome with collective effort by both administration and surgical staff. In conclusion, patients who had a delayed surgical procedure waited on average for 5 days more than those who attended as requested (stayed for 1 day before the procedure was performed). Staff motivation and follow-up of patients booked for surgery two days before the day of the procedure and recruitment of more surgical staff can improve surgical case cancellation.