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  • 1.
    Caesar, Ulla
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Orthopaedics Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Hansson-Olofsson, Elisabeth
    Department of Orthopaedics Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Jon
    Department of Orthopaedics Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Olsson, Lars-Eric
    Department of Orthopaedics Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Lidén, Eva
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    A sense of being rejected: Patients’ lived experiences of cancelled knee or hip replacement surgery2021In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Background

    Growing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden.

    Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients’ well‐being.

    Methods

    In the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach.

    Results

    The comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation.

    Conclusion

    After the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients’ chance of living a pain‐free, active life is postponed.

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  • 2.
    Caesar, Ulla
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Louise
    Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hamrin Senorski, Eric
    Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Jón
    Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Hansson-Olofsson, Elisabeth
    Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Delayed and cancelled orthopaedic surgery; are there solutions to reduce the complex set of problems?: A systematic literature review.2021In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241Article in journal (Refereed)
    Abstract [en]

    Background: Unexpected cancellations of, and delays to, orthopaedic surgery have adverse effects, with a negative impact on hospital performance and undesirable patient outcomes. As cancellations and delays are common, finding measures to prevent them is a matter of urgency.

    Methods: The present systematic review conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook. Peer-reviewed studies reporting on cancellations or delays in patients requiring emergency orthopaedic or planned orthopaedic surgery that compared care action/intervention with no action or traditional care were included. The Grading of Recommendations Assessment, Development and Evaluation used to assess the quality of evidence of the results from the included studies. The objective of the present study was systematically to search and review the literature for qualitative evidence of factors that might reduce cancellations of and delays to orthopaedic surgical procedures.

    Results: The electronic search yielded 1209 studies and eight articles were included in the performed quality assessment. The heterogeneity of the studies and the lack of calculations and statistics in the studies resulted in no meta-analysis. The result of the quality assessment indicated that the evidence ranked from low to very low across the different outcomes. The main limiting factor, which was the reason for a decrease in quality in some outcomes, was the study designs, which were non-randomised control or retrospective approach. The interventions in the included studies could help to support a reduction in the risk of cancelled and delayed orthopaedic procedures.

    Conclusion: This systematic literature review has revealed important evidence to help reduce the risk of cancelled and delayed orthopaedic procedures associated with a variety of care action exposures. They include a fast-track pathway, pre-operative guidelines and telephone contact with patients prior to surgery, as well as careful consideration of additional pre-operative tests.

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  • 3. Caesar, Ulla
    Delayed and cancelled orthopaedic surgery: Causes and consequences2019Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Extended waiting time, over-booked waiting lists and cancelled and delayed surgical procedures are realities for some patients treated at orthopaedic clinics in Sweden. This situation affects the prioritisation procedures for both emergency and elective surgery and results in even longer waiting lists, not only for planned patients, but for emergencies as well. Methods: Studies I and III were retrospective, observational, single-centre studies with data collected from the hospital’s registers. The aim was to evaluate and describe the number and reasons of delays and cancellations, as well as the waiting times. Study I included 17,625 elective patients over a period of five years and Study III, of 36,017 emergency patients over seven years. The design in Study II was qualitative, aimed to elucidate lived experiences of patients being cancelled of replacement surgery. The 10 interviews were analysed by phenomenological hermeneutic method. Study IV was a systematic review of literature in evidence of factors used to reduce cancellations and delays of orthopaedic procedures. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook were used as guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence in the included studies. Results: In Study I, 39% of all patients received at least one, some several cancellations. The most common reasons were various patient-related factors 33%. The median waiting time for those cancelled once was 54 days. In Study III, 24% of all patients scheduled for emergency surgeries were delayed, 80% of these were organisational reasons; 21% of all delays were rescheduled within 24 hours, whilst 41% waited more than 24 hours up to three days. In Study II the comprehensive analyses revealed that the participants described their feelings as not being the chosen one and thereby feeling rejected. And described the cancellation using words with connotations to physical pain, like feeling hurt. The relationship between the participant and the health-care provider appeared to be damaged by the cancellation. Study IV included eight articles. The analysis indicated that the evidence was ranked from low to very low across the different studies. The main limiting factor, also the reason for a decrease in quality, was the designs. Conclusion: In Study I more than a third of the patients had their surgery cancelled and in Study III almost one-fourth had their emergency surgery re-scheduled. One possible way of influencing the high rate of the elective patients’ cancellations, might be to involve them more in the overall planning of the care process. In Study III the results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays negatively affect patient outcomes. The result in Study II is promising first step towards building a better understanding on patients experiences of having a surgical procedure cancelled. These new evidence gives possibilities to reflect, develop and improve care. Study IV revealed items that might be useful to help reduce the risk of cancelled and delayed orthopaedic procedures.

  • 4. Caesar, Ulla
    Svåra känslor vid uppskjutna operationer2019In: OmvårdnadsmagasinetArticle in journal (Other (popular science, discussion, etc.))
  • 5.
    Caesar, Ulla
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bakomliggande orsaker till fördröjningar av oplanerad ortopediska ingrepp: en studie av 36 017 fall över sju år2018Conference paper (Other academic)
    Abstract [en]

    Introduction Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit or the patients’ health status has been optimised. This affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. Patients and Methods The purpose of the retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. Results We found that 24% (8,474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. 80 % of these delays were due to organisational causes. 21 % of all the delayed patients had surgery within 24 hours, whilst 41% waited for more than 24 hours, upto three days. Conclusions Much of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes. 

  • 6. Caesar, Ulla
    Delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years2018Conference paper (Refereed)
    Abstract [en]

    Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit or the patients’ health status has been optimised. This affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. Purpose of the retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8,474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. 80 % of these delays were due to organisational causes. 21 % of all the delayed patients had surgery within 24 hours, whilst 41% waited for more than 24 hours, up to three days. Much of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes. 

  • 7. Caesar, Ulla
    Delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years2018Conference paper (Other academic)
    Abstract [en]

    Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit or the patients’ health status has been optimised. This affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. Purpose of the retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8,474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. 80 % of these delays were due to organisational causes. 21 % of all the delayed patients had surgery within 24 hours, whilst 41% waited for more than 24 hours, up to three days. Much of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes. 

  • 8.
    Caesar, Ulla
    et al.
    Sahlgrenska Academy, Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg Sweden, Gothenburg, Sweden.
    Karlsson, Jon
    Sahlgrenska Academy, Institute of Clinical Sciences, Department of Orthopaedics, University of Gothenburg Sweden, Gothenburg, Sweden.
    Hansson, Elisabeth
    Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg Sweden, Gothenburg, Sweden.
    Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years2018In: Patient Safety in Surgery, E-ISSN 1754-9493, Vol. 12, no 1Article in journal (Refereed)
    Abstract [en]

    Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit and/or the patients’ health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies.

  • 9.
    Caesar, Ulla
    et al.
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45, Gothenburg, Sweden.
    Karlsson, Jón
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45, Gothenburg, Sweden.
    Olsson, Lars-Eric
    Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Samuelsson, Kristian
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45, Gothenburg, Sweden.
    Hansson-Olofsson, Elisabeth
    Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases.2014In: Patient Safety in Surgery, E-ISSN 1754-9493, Vol. 8, no 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery.

    METHODS: The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once.

    RESULTS: Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.

    CONCLUSIONS: In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process. 

  • 10. Caesar, Ulla
    Mer än var tredje inbokad operation bokas om, skjuts upp eller avbokas2014In: Uppdukat, ISSN 1101-5624, Vol. 26, no 4Article in journal (Other academic)
    Abstract [sv]

    Som ett led i Ulla Caesars doktorandarbete vid Sahlgrenska akademin har förekomsten av ombokade, uppskjutna eller på andra sätt avbokade operationer vid ortopedikliniken på Sahlgrenska universitetssjukhuset kartlagts Mer än en tredjedel av alla planerade operationer inom ortopedisk kirurgi ombokas, skjuts upp eller avbokas helt. De vanligaste orsakerna är att patienten själv avbokar eller att akuta operationer måste prioriteras. Det visar studien som genomfördes i samarbete med Sahlgrenska Universitetssjukhuset. 

  • 11. Caesar, Ulla
    et al.
    Leman, Gunilla
    Handledarrollen för specialistsjuksköterskor inom anestesi, operation och intensivvård2007In: Uppdukat, Vol. 3Article in journal (Other academic)
    Abstract [sv]

    Inom Verksamhetsområdet AnOpIva finns två operationsenheter; Kvinnoklinikens operationsavdelning , Centraloperation och en Intensivvårdsavdelning. För att stärka handledare som handleder specilaistsjuksköterskestudenter inom verksamhetsområdet genomfördes ett projekt för att kartlägga och stärka handledarrollen och samarbetet med GU/ Institutionen för vårdvetenskap och hälsa. 

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