Presurgical Evaluation Case Study: Improving Presurgical Evaluation to Optimize the Daily Schedule

According to the Healthcare Cost and Utilization Project (HCUP) the total number of surgeries at community hospitals in the United States increased by 17% to about 26.8 million procedures in 2015. Is your hospital’s presurgical evaluation and screening process performing at an optimum level?

The Client

Discover how Sullivan Healthcare Consulting perioperative consultants implemented process improvements for a large community hospital struggling with unproductive preadmission testing and presurgical evaluations, and lengthy patient stays.

The Challenge

  • Identifying opportunities for improvement in preanesthesia testing (PAT) and presurgical screening (PSS), to ensure that patients were clinically ready for surgery

  • Hospital considered constructing a new PAT/PSS clinic

  • Wanted to ensure best practices were incorporated in design

How Our Perioperative Consultants Improved Presurgical Evaluations

Our perioperative consultants partnered with the hospital’s surgery governance committee to implement the following:

  1. Reengineering the PAT process to ensure 100% of elective patients were properly screened and prepared for surgery

  2. Establishing a cutoff time of noon the day prior to surgery for completion of elective case charts

  3. Recommending the development of standard screening and testing criteria for the department of anesthesiology

  4. Training RNs on the efficient use of a standardized phone screening tool

  5. Establishing a daily multidisciplinary “huddle” to review patient readiness for surgery

  6. Establishing a “stop-the-line” process if all elements were not in place by noon the day prior to scheduled surgery

Our Results

  1. Established a newly designed PSS version of the daily OR schedule indicating special patient conditions and readiness, which increased consistency and streamlined communication

  2. Developed and implemented an anesthesia screening tool

  3. Increased nursing efficiency by creating a standardized screening process

  4. Reinforced and maintained the daily huddle

  5. Put in place a procedure for the anesthesiologist in charge or an OR director to contact surgeons directly regarding cases that needed to be rescheduled due to incomplete patient information

Ongoing efforts using LEAN process improvement initiatives resulted in further improvements:

  1. Changed the target time from noon to 11:00 AM so that by noon, virtually 100% of charts were completed

  2. Created a “red folder” of patients who screened positive, with anesthesiology reviewing information daily during the huddle and managing cases according to patient need

  3. Established a standard faxing location in PSS using RightFax so that all faxes could be electronically tracked

  4. Ensured that all activities and improvements were compatible with the anticipated implementation of a new, computerized management system

  5. Improved staff, surgeon, and anesthesiologist job satisfaction and utilized resources more efficiently

Implementation Support

During implementation, our perioperative consultants provide hospital administration with a list of quantitative measurements that identify where they started, six-month goals, and long-term/final goals. Our team of experts can ensure that the implementation of recommendations will result in a more-than-adequate return on investment.

To learn more about our services and how Sullivan can help improve your organization’s performance, contact us today.

Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.

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Orlando, Florida 32817

​​Tel: 866-303-8968



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