Cancellations reduced on day of surgery
Preop screening and assessment uses checklist
After a nurse-driven preoperative screening and assessment for reducing day-of-surgery (DOS) cancellations and other protocols were implemented in northeast Pennsylvania ambulatory surgery centers (ASCs), no-show cancellation rates were 120% higher in patients who did not have the preop screening and assessment done.
"Transportation-related and protocol-related day-of-surgery cancellations decreased by 28.5% and 22.4%, respectively, in patients who received a preoperative screening and assessment using a standardized checklist," said Lea Anne Gardner, PhD, RN, senior patient safety analyst for the Pennsylvania Patient Safety Authority. The ASCs collaborated with the Pennsylvania Patient Safety Authority in Harrisburg on the project.
11 ASCs were involved
From January 2012 through June 2013, the authority conducted an 18-month collaborative improvement project with 11 ASCs in the northeast region of Pennsylvania.
"The project focused on day-of-surgery cancellations because preoperative screening on the day-of-surgery is the last opportunity to catch medical conditions that would place patients at risk for complication and rearranging schedules due to last-minute cancellations, which creates opportunities for mix-ups with patient names, procedures, or medications," Gardner said.
A DOS cancellation was defined as a cancellation of a scheduled procedure or surgery that occurred after 12:01 a.m. on the DOS for any reason. DOS cancellations occurred prior to admission, after admission, and after anesthesia.
The ASCs achieved a 9.7% reduction in their DOS cancellation rate, from 29.6 DOS cancellations per 1,000 completed procedures preintervention to 26.8 DOS cancellations per 1,000 completed procedures postintervention.
Gardner said a closer look at patients without a preoperative screening showed a greater percentage of no-show cancellations.
"No shows on the day-of-surgery drop 10-15% if a preoperative screening and assessment is performed. That number increases 30-50% if a preoperative screening and assessment is not done prior to the day of surgery," Gardner said. "Selecting appropriate patients for same-day-surgery through the implementation of these interventions can improve patient safety by identifying patients suited for outpatient surgery or procedures, reduce disruptions or delays in the surgery schedule, and increase patient accountability."
During the last phase of the project, two additional interventions were introduced to the ASCs: initiating a second patient preop phone call and incorporating health literacy strategies into patient-staff interactions (e.g., teach-back method and phrasing of questions) and patient-friendly preop forms. A third intervention, done by the authority, was a health literacy conference call that gave ASCs strategies to avoid miscommunication and confusion with the patient by not using medical jargon, etc.
Project information is shared in the March issue of "Pennsylvania Patient Safety Advisory." For more information, go to http://bit.ly/1d3M2H5. The interventions used during the collaborative are also available on the authority’s website www.patientsafetyauthority.org under "educational tools."
Also in the March issue of the "Pennsylvania Patient Safety Advisory" is an update on wrong-site surgery. Ten wrong-site procedures were reported in Pennsylvania operating suites for the quarter 2013. Near-miss reports continue to demonstrate areas of continued weakness and the effectiveness of the evidence-based best practices to prevent wrong-site surgery, the authority reports.
