Why booked surgeries are sometimes cancelled in LUTH

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THE Lagos University Teaching Hospital, LUTH, Idi Araba, is one of the largest and busiest Federal tertiary health institutions in the country.  The LUTH is often in the news for the good, the bad and the ugly. In this chat with Good Health Weekly, the Chief Medical Director, Professor Chris Bode, explains the true state of health services in the hospital.

He gives details about why booked surgeries are  sometimes cancelled or rescheduled, he also touches on important issues such as the state of  hospital–wide consumables committee on consumable deliveries, equipment, industrial actions, and a host of other health services obtainable in the hospital. Excerpts:

By Sola Ogundipe & Chioma Obinna

We have been inundated with so many stories and rumours making the rounds about our services. Unfortunately, as always, nobody bothered to ask for the view of the Hospital’s Management. These issues are sometimes quoted as “some anonymous doctors”.

Even recently, people are talking about shortages of consumables and why surgical operations are rescheduled but I want to reassure Nigerians that there is no shortage of “consumables” in LUTH and that surgical operations take place as scheduled in LUTH.

Prof Chris Bode

In fact, there has been a strengthening of the process of supplying requisite items for the daily business of patient care in LUTH.

These days in LUTH, all consumable items from reagents, stationery, dressings, gloves, cannulae and cleaning materials are bulk-purchased and delivered to end-user Departments. That way, the end-users who now sign for these items in bulk no longer complain of non-supply. It has worked wonderfully well for most departments since it was initiated almost a year ago.

Why surgical operations are cancelled

Although infrequent, cancellation of booked surgical operations can occur for various reasons in any hospital. These are broadly categorised into factors relating to patients, hospital systems and “Acts of God”.

In a number of quality improvement studies at our centre, patients’ factors such as fever, upper respiratory tract infection, feeding on the day of operation contrary to instructions or forgetting to turn up are some of the commonest reasons contributing to more than 45 percent of reasons for surgical cancellations.

Life-threatening emergencies sometimes truncate an operation list as non-emergency operations may then have to be rescheduled to save lives in peril. An unanticipated complication in an ongoing operation may also lead to postponement of an earlier planned procedure. Sometimes, infrastructural failures such as breakdown of a dedicated generator backup, a dysfunctional autoclave or some other equipment failure may adversely affect the list, leading to cancellations.

Lastly, social strife, fuel scarcity, unscheduled public holidays, strikes and other occurrences over which nobody has a control may decide for us whether or not a case is operated. Just as with airline pilots who will not fly until convinced all bases have been covered, a surgeon will insist on optimal conditions for the outcome of his work.

As a responsible hospital, we try our best to minimise the controllable variables such as patient factors and Hospital-related factors.

We screen patients and instruct them through multiple methods to ensure they are fit for surgery. Within our means, equipment maintenance is given top priority and these days, virtually no equipment is bought without plans to maintain it.

In spite of these, and especially because we rely continuously on generators, the occasional breakdown is not unknown but these are explained to each patient affected and the earliest next schedule is made to expedite their cases. The gas pipeline to our Independent Power Project is being laid and we envisage the era of erratic power supply will be over in the first quarter of this year.

391 surgeries in Jan 2017

In January 2017, a total of 391 surgeries were performed at the LUTH. This figure is typically lower than our usual monthly returns simply because Nigerians loath to spend December and January on admission. It is culturally unpalatable.

From February 1-9, 2017, a total of 141 operations were performed in our theatres. Many who could not pay were not discriminated against. Twenty-nine cases were postponed in the past weeks for reasons of being unfit to undergo scheduled operations, patient declining operation at the last minute, other life-threatening emergencies, explosion of a transformer and a sudden generator breakdown. This is within international acceptable limits for our sub-region.

Our Intensive Care Unit is full and to the best of our capability, the Lagos University Teaching Hospital is contributing its quota to the upliftment of the people’s health.

Over 100 cancer patients treated daily: In LUTH, the Linear Accelerator machine (LINAC) used to treat cancer is probably the only one of its kind still working in Nigeria as of today. It is more than 12 years old and at the end of its life.

Nigeria once has seven such machines but ours is one of the two or possibly the only one working. It treats over 100 patients each day. It is however prone to breakdowns and our engineers strive strenuously to maintain it. Sometimes, we send for assistance from its overseas makers, though they have stopped producing this particular model.

In consonance with other affected hospitals, we are in talks with various levels of government to urgently replace this equipment that will cost over $4 million. In fact, LUTH alone requires more than one such machine to cope with its cancer patients. It is palpably unfair to the courageous men and women who toil tirelessly every day giving succour to cancer patients in LUTH when people blame the Hospital for the breakdown of a machine that everyone knows already requires a replacement and which is not manufactured in our country.

It would have been more helpful if people could use their clout to unlock sources of funding from Nigerians to procure a new LINAC for LUTH and assist suffering fellow men and women.

Incessant industrial actions

There was a year, not long ago, when our workers were on strike for almost eight months and we were all paid in full. The new stance of government which insists on No-Work-no-Pay has stopped all that and rendered impotent the erstwhile powerful strike barons of yore. In the past four months alone, one such body has tried five times to call its members out on strike but nobody heeded the calls as Government is sternly enforcing the no-pay-for-no-work rule.

Public trust: Public trust has returned and we are able to plan ahead, render services, perform training activities and collaborate with international bodies to reclaim our prideful place at international fora. Corporate agencies are beginning to show confidence in our capabilities and LUTH is once again attracting human and material capital for the much needed system upgrades.

Things are working in LUTH and we are constructively holding our own in these tough times. Any patient who requires attention for any aspect of their care has ready access to the Hospital Management’s open doors and all are attended to without any bias. Rather than suffer in anonymity, every LUTH client has ready channels to approach the Management if dissatisfied because anonymity is not the best choice when one is truly ill.

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