Rural: Overview

Abstract
Background: Reasons for elective surgery cancellations and their impact vary from one institution to another. Cancellations have emotional and financial implications for patients and their families. Our service has a particularly broad and geographically diverse patient population, hence we sought to examine these impacts in our service.

Methods: We identified families with procedural cancellations and administered a telephone questionnaire. Survey items included the reason for and timing of cancellation, how the family was informed, the mode of transport and distance travelled to the hospital, associated leave from work, expenses, whether the child was required to fast, missed school, as well as the child's and parent's emotional responses to the cancellation, along with overall parental satisfaction with how the cancellation was handled.

Results: During our study period a total of 7870 procedures were booked. 6734 (86%) of these were completed and 1136 (14%) were cancelled, with 6% cancelled on the day of surgery. In 750 (66%) of these cancellations, families were successfully contacted by telephone and agreed to participate. Of these 305 (41%) cancellations were family-initiated and 444 (59%) were hospital-initiated, with these hospital-initiated cancellations occurring closer to scheduled surgery. The most common cause of cancellation was that the child could not undergo the procedure due to illness (22%) or being unable attend the hospital (14%). The greatest disruption to families and children occurred when procedures were cancelled late, particularly when the cancellation occurred on the day of the planned procedure.

Key points:
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Abstract
Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. A retrospective before-after cross-sectional study was conducted at the Alice Springs Hospital ICU between 1 October 2017 and 30 September 2019. The primary outcome was the proportion of admissions in which alcohol misuse was a contributing factor in the 12 months before (pre-reforms phase) versus the 12 months following (post-reforms phase) implementation of alcohol legislation reforms. Secondary outcomes were measures of critical care resource use (length of stay, need for and duration of mechanical ventilation). After exclusions, 1323 ICU admissions were analysed. There was a reduction in the proportion of admissions associated with alcohol misuse between the pre-reforms and post-reforms phases (18.8% versus 11.7%, P < 0.01). This was true for both acute (10.6% versus 3.6%, P < 0.01) and chronic misuse (13.3% versus 9.6%, P = 0.03). Rates of mechanical ventilation were unchanged during the post-reforms phase (18.3% versus 14.7%). Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.