13 steps to convert to 45-minute arrivals
Patients show up day of surgery for first time
By Stephen W. Earnhart, MS
CEO, Earnhart & Associates
Austin, TX
In my recent column, I lashed out at facilities that require patients to arrive an hour or two or more before their surgery time. I thought then and still think this is unnecessary and a waste of the patients' valuable time. I also said that making patients take a day off from work to come to the center for their anesthesia interview and pre-op testing a few days before surgery is further wasted time and an inconvenience.
I received quite a response from you. The majority of the feedback was positive, and the others were asking "how?"
Let me explain my premise for having the patient arrive at your facility for the first time the day of surgery, 45 minutes before. Right now most facilities, to minimize delayed or canceled cases, penalize all patients by making them arrive hours before their surgery and days before their surgery for testing. Reverse that! It is an overwhelming inconvenience and one of the greatest complaints on patient satisfaction surveys.
An excuse that facilities often use for having patients arrive hours before their posted surgical time is the surgeons want the patients there so they can move up patients if some patients are "no-shows" or if a second room opens up. This is a frequent issue with pain management, GI, cataract, and other high-volume, quick-turnaround cases. This issue needs to be addressed in a conversation between you and the surgeon! You can pretend the issue isn't there, or let the surgeon know that your staff will make every effort to minimize no-shows so you do not need to "cattle call" patients.
Let me first state some facts on pre-admission testing. For the average outpatient surgery patient (ASA 1 and 2) having elective surgery, most preop testing is a waste of time and money. Remember that the facility does not require any preop testing! You are bricks and sticks! The testing required is determined by anesthesia personnel or the surgeon, with anesthesia taking the lead. The reason some anesthesia personnel or surgeons order such extensive and expense testing is mostly defensive and, again, unnecessary. Sit down with your medical director and discuss what tests are being routinely ordered. Find out what you can eliminate or modify. If everyone is comfortable with it, change them. Remember that if anesthesia or the surgeon orders the tests, they also have the ability to waive them if they think it is indicated. If the facility orders the tests, you cannot waive them! Let those tests be between anesthesia and the surgeon. Stay out of it.
So, how can you have patients arrive 45 minutes before their surgical slot and not mess up your schedule? First, address the above issues. Meet with your staff, and listen to their suggestions. They will be skeptical. I can assure you this will not work without everyone's support.
Here is how it will work for most of you. (Not all!)
- Receive internal approval to move forward from medical director, department head, administrator, etc.
- Address the issues above.
- Have anesthesia personnel call the patient two or three days before their surgical date and perform their assessment.
- A couple of days before, have the nurse call patient and perform the nursing assessment.
- Make sure patients know they need history & physicals (H&Ps).
- Make sure patients know they (might) need pre-admission testing and to have it completed at __________ (fill in the blank).
- Make sure patient knows what time to be there and where you are at that address!
- Make sure they stay NPO, etc.
- Make sure any issues that arise from number 3 and 4 above are addressed, and make appropriate responses. Some of these responses could be to order more pre-op tests, have a one-on-one visit, obtain clearance from the local medical doctor over and above the H&P, etc.
- When patients arrive at the facility assume they will and be on time; affirm it follow your normal pre-admission routine.
- If patient needs lab work or it is not available, perform appropriate testing on-site (H&P, pregnancy, blood sugar, etc). All can be done in under 30 minutes! Yes they can!
- Move them into pre-op.
- Perform surgery as usual.
I can assure you it works, but only if you want it and allow it. You can come up with many reasons why it will fail at your center, but the reality is that it can and is being done.
Will there be late patients? Of course! Will there be missing lab work or H&Ps? Definitely! But it will be for less and less each week while you perfect the process. After a while, it will become second nature. You can make a difference. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: [email protected]. Web: www.earnhart.com. Tweet address: Earnhart_EAI.]
In my recent column, I lashed out at facilities that require patients to arrive an hour or two or more before their surgery time.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content