DOI: 10.69554/dsbi4482 ISSN: 2397-1061

Tackling anaesthesiology service bottlenecks and inefficiencies in preoperative care in Spain

Ancor Serrano-Afonso, Carlos Jiménez-Padilla, Roger Añor-Grasa, Maria J. Colomina
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The demand for anaesthesia continues to grow, with procedures becoming more complex and involving higher-risk patients. Pre-anaesthesia evaluation (PREANE) is essential for risk stratification, optimisation and decision making, yet inadequate preparation often leads to the cancellation of elective surgeries. This study examined challenges in preoperative management within Spanish hospital anaesthesiology services, focusing on last-minute cancellations (LMCs), bottlenecks and hidden workforce burdens. Qualitative interviews were conducted with 18 heads of anaesthesiology departments to identify inefficiencies in perioperative care. The major issues found were staff shortages, inconsistent preoperative circuits and poor preparation (PPP), which sometimes led to surgeries performed under suboptimal conditions. Among hospitals reporting data, the average LMC rate due to PPP was 1.82 per cent, equating to nearly 66,600 cancelled procedures annually across Spain’s public health system. Cancellations most often stemmed from unreviewed preoperative recommendations and insufficient staffing for evaluations. Interviewees linked LMCs with hospital inefficiency and negative patient outcomes, including prolonged stays and higher complication rates. Findings revealed a 10 per cent deficit in anaesthesiology staff and frequent reliance on non-medical personnel for assessments. Most hospitals lacked key performance indicators (KPIs) to monitor suboptimal surgeries, although adverse outcomes could be inferred from increased intensive care use and lengthened hospitalisations. The study concludes that systematic data collection, standardised PRE-ANE pathways and better alignment of resources are essential. Integration of AI and machine learning into preoperative processes may further improve patient selection, reduce cancellations and strengthen departmental workflows. This analysis offers healthcare managers a reference framework to address inefficiencies and proposes actionable strategies for enhancing preoperative management in Spanish anaesthesiology services. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.

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