Working Toward Zero Preventable Delays in Surgical Services
A well-functioning Preanesthesia Screening (PAS) program prepares patients for surgery prior to the day of surgery. PAS affects the day of surgery by minimizing surgical services delays, unanticipated workups, and potential case cancellations. These negative events directly impact the patient, physician, and staff experience while decreasing the efficiency and throughput of the preoperative department.
Minimizing Delays in Surgical Services
Mitigating delays on the day of surgery requires proactive patient care planning initiated prior to the patient leaving the surgeon’s clinic. Clearly defined preanesthesia guidelines should be evidence based and data driven, which will lead to preoperative testing that is appropriate and specific to each patient.
The industry trend is to communicate clearly through anesthesia-driven protocols that keep decision-making within the anesthesia scope of practice. When patients and office staff know exactly what is required to prepare for the day of surgery, coupled with robust nursing assessments, preventable delays are minimized and/or eliminated.
How to Work Toward Zero Preventable Surgical Service Delays
Preoperative patient care planning begins during the consulting appointment when the patient decides that a surgical intervention is the best option. The surgical clinic or office is the best place to capture all of the patient information needed to minimize unexpected events resulting in preoperative delays.
Preparing a plan of care includes determining and obtaining:
Which provider will provide the H&P within 30 days of the procedure
NPO status and instructions
Medications to take or not to take as recommended by anesthesiology
Patient’s driver post-procedure
Consent that aligns with the scheduled procedure
Discharge planning needs
Rely on an Experienced Anesthesia Medical Director to Develop Testing Guidelines
Clearly defined anesthesia guidelines, based on current literature and national standards of practice, ensure that patient preparation activities will produce meaningful data that facilitates anesthesia care planning.
The PAS program needs an anesthesia medical director to lead the development of testing guidelines—defining which tests and consults are required based on the patient’s comorbidities to minimize unnecessary and redundant testing.
The criteria used in current literature is: Will the result of a test, exam, or consult change the anesthesia plan of care? If the answer is no, then that test is deemed unnecessary. This process of challenging current testing protocols assists in narrowing down to meaningful testing based on patient comorbidities.
Clear Medication Guidelines for the Day of Surgery
A set of clearly defined medication guidelines also needs to be developed so that the clinic or office and PAS nurses can instruct patients on what to take and what to hold on the day of surgery. Specifically, perioperative recommendations defining, at minimum, which medications to take on the day of surgery and which to hold and for how long. Medication guidelines should also detail who will manage the process if bridging is needed for anticoagulants/antiplatelets.
Defined Roles and Managing Medications
Medication guidelines should detail which provider will manage the process for:
Chronic pain medications
Opioid addiction medications
Chronic steroid use
Any other medication that can affect anesthetics
Preprocedural consults need to be addressed by anesthesia. Questions such as:
When are they required?
How far from the day of procedure is acceptable?
When should they be repeated?
What type of consults are necessary?
When these elements are used together, a patient can leave the office or clinic with a well-defined plan of care that is customized to his/her medical history and which reduces delays for surgical services.
Establish Baseline Data
Measuring the success of a preanesthesia screening program begins with tracking preventable delays and case cancellations on the day of surgery. Successful programs also actively monitor patient care metrics and define preventable day-of-surgery delays to establish baseline data.
It is critical that charts for electively scheduled patients be complete by noon the day before surgery to ensure efficiency. Patients that have incomplete charts represent preventable delays. This hinders anesthesiology from reviewing the charts ahead of time. Escalating communication regarding incomplete charts is crucial in order to minimize the impact to the patient and prevent further case delays/rescheduling.
Define what constitutes a complete chart.
Communicate and educate to improve patient care and minimize delays/cancellations in surgical services.
Calculate the percentage of elective charts complete at 3 days, 2 days, and 1 day prior to the day of procedure.
Establish that goal that 100% of elective charts be complete by noon the day prior to the procedure.
Highlight the effectiveness of the coordinated preoperative patient plan of care that creates a smooth admission process on the day of surgery.
Proactive Patient Care Planning for Minimizing Surgical Services Delays
Preoperative patient care planning begins with the patient’s decision to proceed with a procedure as outlined by the surgeon during the consultation. Initiating a preanesthesia plan of care based on anesthesia guidelines should occur before the patient leaves the office.
A successful preanesthesia plan also communicates to patients what is expected of them and where and when to get tests done. Before the patient leaves the office, ensure that the patient file includes test results, consultation notes, and history and physical if available, or make plans to obtain these. This proactive planning approach keeps patient records together so that preoperative telephone screening can occur seamlessly. These combined efforts minimize preventable delays and case cancellations related to missing chart components.
Proven Track Record of Implementing Best Approaches
Sullivan Healthcare Consulting has implemented best approaches to preanesthesia screening programs in hospitals across the country. These programs have consistently minimized or eliminated preventable delays on the day of surgery.
For example, our perioperative consultants recently assisted a large metropolitan hospital running 18 ORs where first case delays were consistently running 13%, or 2.3 ORs each morning. During communication and education of the new program, preventable delays dropped to 7%, a 50% improvement. Feedback from office staff confirmed that our protocols eliminated guesswork, streamlined their internal processes, and decreased the number of phone calls to the office for missing chart components.
Read our case study, "Improving Presurgical Evaluation to Optimize the Daily Schedule," to learn more about our approach and the value of partnering with Sullivan Healthcare Consulting.
To learn more about how Sullivan Healthcare Consulting can help reduce preventable surgery delays, contact us today.
Tammy Tenerowicz has more than 31 years of nursing healthcare experience, with more than 27 years in perioperative services and leadership. She is focused on improving the quality of patient care through clinical, operational, and productivity improvements while practicing prudent fiscal administration. Her wide-ranging consulting experience has included perioperative program assessments, implementation assistance, program development, anesthesia practice management, perioperative business management, training and mentorship, and sterile processing program leadership.