How to set up a one-stop preadmission department
October 1, 1999 3 minutes read
Streamlining Pre-op
How to set up a one-stop preadmission department
Setting up a surgical preadmission department to handle everything from registration, financial arrangements, lab tests, and home care instructions requires a detailed assessment of needs and planning that includes input from everyone affected.
While a lot of effort goes into the project, it is worth it, says Jean Kirchner, RN, CNOR, director of patient access services at Munson Healthcare in Traverse City, MI. "This is the third preadmission department I’ve set up during my career, and it has always been worthwhile," she says.
Delays and cancellations of surgery are costly to a day-surgery program, and they are unnecessary if they occur due to charts not being completed on time, Kirchner points out. You also can improve the patient’s surgical experience by making sure he or she knows exactly what to expect during and after surgery, so patient education before surgery is important, she adds.
The preadmission department at Munson Healthcare handles all registration activities, lab or other diagnostic or screening tests, patient education, nurse assessment, and anesthesiologist assessment in one location.
Patients visit the department, often with an appointment, one month to 24 hours before their scheduled surgery. Preadmission nurses pull charts for review 24 hours to 72 hours before surgery to make sure test results, history and physicals, and all other necessary items are on the chart. If there is something missing, there is time to track it down before surgery, explains Kirchner.
The first step in setting up the preadmission department was to look at what types of surgery are handled, what types of tests are routinely ordered, and what current pre-op process is involved, says Kirchner.
The next step was to put together an advisory group that included representatives from the departments involved as well as representatives from the physician office staffs that scheduled patients for surgery. "The physician office staffs are critical to our department’s ability to succeed," says Kirchner. "We need information from them to get the patient ready for surgery, so we wanted to make sure our process would meet their needs and expectations as well as ours."
Not only did the physician office staffs meet as part of an advisory board that developed forms and procedures, but Kirchner’s staff sponsors a luncheon for the physician staff four times each year to bring them up to date on the preadmission department activities. "We also send a newsletter every two months that highlights changes in procedures and gives kudos to different people who have made the process work," adds Kirchner. Physicians were not as enthusiastic about the changes made by the preadmission department because there was no leeway given for missing history and physicals, says Kirchner. "We met with the vice president of medical affairs, the chief of surgery, and the chief of anesthesiology to get their support, then they made the rounds of department meetings to support our efforts."
No additional full-time equivalents (FTEs) were required to set up the department. "We just moved existing FTEs from existing patient accounts and registration staff," Kirchner explains.
The main goal of the preadmission department is to eliminate redundancy in the pre-op process, so the patient isn’t giving the same information to multiple people, and to make it easier for the patient to move through the process, she adds.
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