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Three Keys to Curbing Surgical Cancellations

More than 57% of surgical procedures are now performed on an outpatient basis, making it a key revenue generator for hospitals and ambulatory surgery centers (ASCs) alike. In fact, gross outpatient revenue at hospitals has steadily, significantly risen year on year — gross revenues from outpatient procedures totalled $887.4 billion in 2010, up 10.5% from 2009 — and is outpacing growth in revenues related to inpatient care.

As a result, making sure that surgeries are performed according to schedule is more important than ever. Cancellations result in lost revenues, wasted time and misappropriated staff resources. Avoiding surgical cancellations can be achieved through communicating effectively with patients, utilizing screening best practices, and ensuring the exchange of accurate and detailed patient information between providers and facilities. Here’s a closer look at what your physicians, nurses and facility can do to minimize outpatient procedure cancellations on the day of surgery.

1. Communicating effectively with patients

The American Academy of Orthopaedic Surgeons recommends that providers sit down during patient encounters; develop an understanding of the patient as an individual, not as a disease; show empathy and respect; listen attentively to create a care partnership; elicit concerns and calm fears; answer questions honestly; inform and educate patients about treatment options and the course of care; involve patients in decisions concerning their medical care; and demonstrate sensitivity to patients’ cultural and ethnic diversity. These objectives can be achieved only if the physician is able to focus on the patient during their encounters — not scribbling notes on a chart, or typing information into an electronic health record (EHR). Using scribes to input the full complement of patient information in real time relieves physicians of this distraction, letting them pay attention to patients in a way that enhances the chances they will show up for their procedures on time and ready to go. Further, technology such as email and text alerts, and screening forms that can be filled in online, can keep lines of communication open with patients between the consult and the day of surgery.

2. Utilizing screening best practices

recent study published in the Pennsylvania Patient Safety Advisory, a publication of the Pennsylvania Patient Safety Authority, tracked surgical cancellations at 11 ambulatory surgical facilities in Pennsylvania to explore day-of-surgery (DOS) cancellations. The authors found a statistically significant difference between no-show DOS cancellation rates in patients with and patients without a pre-operative screening and assessment. Changes in the patient’s medical condition and no-show cancellations accounted for 47.7% of the DOS cancellations. Nurse-driven pre-operative screening and assessment — to flag up issues for the surgeon or anesthesia provider — helped to reduce patient cancellations. These assessments could ameliorate issues such as incomplete or missing history and physical forms, ensuring that the required information is on hand and triaged for review by a more specialized provider where necessary.

3. Ensuring accurate patient information sharing between providers and facilities

The most frequently reported reason for a DOS cancellation in the Pennsylvania study was a change in the patient’s medical status — something that cannot be caught out by nurse screening alone. Many times, the primary care physician’s or surgeon’s office is aware of issues that have arisen, but the facility where the surgery is scheduled to take place has not been informed. When patients present with new undiagnosed medical conditions, exacerbation of existing medical conditions, cold symptoms or infections — or even improvements in the medical condition that no longer require treatment, for example – delays in transcribing notes or incompleteness of records are often to blame. It’s just another reason the use of scribes in day-to-day care is so important: their thorough, time-efficient input of patient information enables sharing between providers and facilities, avoiding snags in the care schedule, such as DOS cancellations.