Same-Day Surgery Manager: Technology is more than just equipment
By Stephen W. Earnhart, MS, CEO, Earnhart & Associates, Houston, TX
In preparing for a presentation I'm making on accountable care organizations (ACOs), I am realizing, more than ever, the cost to healthcare for not utilizing the technology that is available to our facilities. The cost is not only in dollars, but in pain, suffering, and hardship that this lack of utilization places on our patients. We can take payments and make deposits on our cell phones for services, but we cannot get an accurate accounting of what medications our patients are taking on a daily basis before surgery.
Twenty percent of what is spent on healthcare in this country is in response to complications from the services we provide to our patients. Twenty percent of over a trillion dollars a year is significant — due to errors! Billions of more dollars more could be saved by elimination of duplicate services and tests that we order on patients who already had them. Not all these costs are from surgical patients, but a significant portion comes directly from the operating room.
What can we do?
Electronic health records (EHR) are the key component of reducing these errors and cost of duplication of services. Populating the electronic record with the patient's current and past tests, medications, complications, operations, and outcomes is a start for us. There are many reasonably priced companies that provide this service to us now, and prices have come down dramatically in just the past year due to competition. If you looked before and didn't want to spend the money, look again.
I recently was part of our audit that we do for operating suites and sat in on several patient registrations the day of surgery. I was amazed at the patients who forgot to list surgical procedures they had in the past, medications they were taking but forgot to mention, complications from other surgeries they didn't mention to the nurse who did the intake days before. One patient forgot that her father had a "real high temperature during surgery that almost killed him."
I always have been a huge proponent of having our patients register online, in the comfort of their living room, with no pressure from the staff person from the center asking them questions about fading events. There is great software out there that has all of the patient's complete health history in one place that can be sent to the surgeon, anesthesia staff, and nursing staff. It is comprehensive and doesn't have to rely on their memory during one phone call or on one sheet of paper they complete when they are under pressure. It is accurate, up to date, and doesn't rely upon spotty memory or stress.
The ability for our staff to check an electronic record on a tablet is far superior to a hastily scribbled and often unintelligible and unreadable note while trying to move the patient out of the room for a quick turnaround. The unpressured thought that went into that record would more accurately determine the care the patient will receive in recovery or on the floor.
The ability of the staff members to read a clearly legible patient chart on a bright, crisp display terminal at the patient's bed is so superior to a piece of paper viewed by one. Inconstancies and inaccuracies are far less likely to make it to an electronic format.
Some last thoughts. With EHR, think of the reduction in delayed cases that will occur with all the lab results on the screen, along with the patient's H&P sent directly from their primary care physician. Think about the online registration ability for the patient to access the map to your facility vs. writing down driving instructions that are rarely understood, which results in further delays.
I know many of you are currently "electronic." For those of you who are not, you are going to be amazed! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates' address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: firstname.lastname@example.org. Web: www.earnhart.com.]