The scheduling/safety intersect
Outcomes improve with scheduling program
Talk about surgical safety and people will automatically think of issues like objects left in a patient after closing or operating on the wrong site. Surgical-site infections are a hot topic. But surgical scheduling? Put that in the PubMed search engine and not much comes up. Add the term "patient safety" and you get a single, lonely article.
But there is a clear link between having a good scheduling program and providing high-quality, safe care to surgical patients, says David Young, MD, founder of the Chicago-based surgical consultancy Surgical Directions and medical director for presurgical testing at Advocate Lutheran Hospital.
Hospitals often allow a bunch of different ways for patients to schedule surgery — telephone, paper, fax, electronic, or even dropping off a document. Young says having a single path to scheduling is the start of safer scheduling. "We don't care how we get it, but we have to written documentation. You can make a reservation by phone, but not actually schedule a procedure."
The rationale is that information heard on the phone may be written down incorrectly, he says. Oral information offers a point at which mistakes can enter the system.
Even faxed forms can be illegible, says Katrina Speers, MA, manager of business and informatics at Advocate Good Samaritan Hospital in Downers Grove, IL.
"From a clinical perspective, using an electronic scheduling program means we have fewer rejections related to issues like antibiotic selection," says Lina Munoz, RN, CPAN, manager of presurgical testing, surgical pavilion and the post-anesthesia care unit at Good Samaritan. Choosing the right antibiotic is a core measure and part of the Surgical Care Improvement Program (SCIP), she says. "We don't have to deal with that using electronic scheduling. There are prompts for the physician order to make sure that the right selection is made."
Currently, that core measure gets a perfect score, Speers notes, while before, there were often issues with that metric.
Munoz says another advantage is to cue physicians and nurses when special care needs to be taken, like when there is a bowel prep. "That can cause renal insufficiency if the patient isn't well-hydrated, so now there is an alert in presurgical testing to initiate a fluid and hydration protocol.
Laterality of surgical site also has a dropdown box, Speers says, cuing a check of the patient record to make sure the right site gets the right surgery. "It adds a layer of safety to recheck that."
Good Samaritan implemented the new scheduling program a little over a year ago, and the results have been significant and positive. Cancellation rates went from 7.7% last year to 0.37% in June. This is a boon to patient and provider satisfaction. There may be outcomes benefits, too, as patients don't have to deal with anticipation and worry of a surgical procedure that doesn't happen, and then gear themselves up all over again.
Presurgical testing is also completed with about two weeks to spare, where before there was just a week of cushion. Munoz says this means there is more time to deal with issues such as comorbidities that may have to be brought under control before a surgical procedure can occur.
The new program was rolled out to the surgical offices after a Lean event at the hospital that found a large amount of front-end waste. "There was a lot of calling back and forth between offices to collect and correct information," Speers says.
Speers and Munoz met one-on-one with the office schedulers and showed them how to use the program. The program vendor tagged along, tweaking the system with almost every comment. "It was really a seamless implementation," says Speers. Within six months, 90% of the scheduling was electronic. Now, it is being rolled out at other Advocate hospitals and within Good Samaritan to interventional radiology and the cath lab. "Everybody loves it."
Before the implementation, some 960 forms a month were rejected. That's been decreased by 90%. What was a full-time employee's worth of wasted time has mostly disappeared.
Next up Speers and Munoz want to leverage the surgical scheduling program to help reduce surgical-site infections and MRSA by adding a screen that includes MRSA colonization test results and antibiotic orders if necessary.
It's not just a matter of putting a name in a time slot, says Speers. It's about making sure that the correct patient information is in the right place in time for surgery, which makes it easier to provide safer surgical care.
For more information on this topic, contact:
• David Young, MD, founder, Surgical Directions, Chicago, IL. Email: [email protected].
• Katrina Speers, MA, Manager, Business and Informatics, Advocate Good Samaritan Hospital, Downers Grove, IL. Email: [email protected]
• Lina Munoz, RN, CPAN, Manager, Presurgical Testing, Surgical Care Pavilion, and Post-Anesthesia Care Unit, Good Samaritan Hospital, Downers Grove, IL. [email protected].
