Objective: The proportion of pediatric patients undergoing surgery on the scheduled date at the General Surgery Department of Children's Hospital 2 was only 59%, affecting operating room utilization and patient flow. This study aimed to identify the causes of postponed or missed scheduled surgery appointments and implement quality improvement interventions to increase the on-schedule surgery rate from 59% to 78% at the General Surgery Department of Children's Hospital 2.
Subjects and Methods: A pre - post quality improvement study was conducted among pediatric patients with scheduled surgery appointments at the General Surgery Department of Children's Hospital 2 from April to September 2024. Root causes of postponed or missed scheduled surgery appointments were analyzed using a fishbone diagram. Four interventions were implemented through three improvement cycles: providing visual educational materials regarding surgical indications, offering flexible surgery scheduling, establishing proactive communication channels, and confirming appointments one week in advance to facilitate replacement scheduling when necessary. The primary outcome measure was the on-schedule surgery rate, defined as the proportion of patients undergoing surgery on the scheduled date.
Results: Baseline assessment of 112 scheduled surgery appointments showed an on-schedule surgery rate of 59% (66/112). Following the intervention, 473 scheduled surgery appointments were evaluated across three cycles. The on-schedule surgery rate increased to 78% (103/132) in cycle 1, 76% (185/243) in cycle 2, and 83% (81/98) in cycle 3, with an overall post-intervention rate of 78% (369/473). The remaining cases of postponed or missed scheduled surgery appointments were mainly attributable to fever, underlying medical conditions, previous surgery at another hospital, and family-related scheduling conflicts.
Conclusions: The quality improvement interventions substantially increased the on-schedule surgery rate from 59% to 78%. Sustained communication with families, preoperative health monitoring, and improved postoperative bed management may help maintain and further enhance these outcomes.