Use the Pre-Op Phone Call to Reduce Cancellations
Do you know the 3 most common reasons for day-of-surgery cancellations? No-shows, violations of NPO requirements and lack of responsible adult escorts. You can decrease your case cancellation rates by improving communication with patients during pre-op phone calls, according to research published in the July issue of AORN Journal. Kimberly Haufler, RN, and Mary Harrington, BSN, RN, the study's authors, investigated the case cancellation issue at the University of North Carolina Health Care ASC and developed a script for the pre-op charge nurse that headed off these cancellation triggers.

• No-shows. Contact patients 3 days before scheduled surgeries and remind them of the date and location of their procedures. Tell them that the facility's secretary will contact them 1 day before surgery to verify the exact time of their arrival. Also verify patients' contact phone numbers, including that of the cell phone they'll be carrying on the day of surgery.
• NPO status. Tell patients why maintaining NPO status is essential to keeping their scheduled start times intact. "It's not safe to have anesthesia with food or other liquids in the stomach." Define which liquids patients can have before surgery (black coffee, water, apple juice or clear soda).
• Adult escort. Tell patients that their surgeries can't start unless they have someone with them at the facility who is over 18 years old, available to stay at the facility for the duration of the procedure and able to drive them home.

After making these improvements to the pre-op phone call, the center realized a 54% decrease in the number of cancelled cases from the previous year. During the 18 months before the program's launch, 6% of patients cancelled on the day of surgery. Afterward, 4.4% did. That decrease boosted overall OR use from 72% to 76%, according to the study. "No one benefits from a procedure cancelled at the last minute, especially in an ASC where there are no other patients to fill the empty OR schedule," the authors write. "Scripting and advance calls by nurses are an effective way to communicate to patients the reasons for pre-operative restrictions and the consequences of not following them."

Daniel Cook

Teddy Bear Clinic Takes Kids Behind the Scenes For our increasing pediatric patient population, a dose of education from those of us behind the scenes of surgery can make the sights and sounds of the perioperative process a little more familiar and a little less scary. So we've begun holding a free, annual, teddy bear clinic at our surgery center on a Sunday afternoon during AORN's Perioperative Nurses' Week in November.

Unlike the pre-surgical assessment tour, in which children scheduled for cases talk with an anesthesia provider and visit the pre- and post-op areas (but not the OR, since we're working in there), our teddy bear clinic invites children from throughout the community — from local schools, churches and scout troops, the families and friends of employees, surgeons and patients — and actually allows them into the OR.

Kids can bring a favorite teddy bear or doll to the event, or make one on site. We take them and their furry friends through the process. First there's admission and wristbands and checking vital signs. Then, in the OR, an anesthesia provider, nurse and surgical tech explain the equipment, anesthesia methods, even why they're wearing surgical masks. The kids place their bears or dolls on the table and we simulate a surgery, anesthesia mask and all. We even demonstrate arthroscopy by sliding a scope into a gelatin mold (into which we've placed jelly beans) and letting them watch on the video monitors.

The "patients" are sent to recovery with a surgical dressing, and they and their owners are given a snack and a certificate of bravery. While we provide them with a short educational program on the importance of nutrition, hand washing and bike helmets, we let adults examine a display of surgical equipment. Overall, the event makes the facility into a fun, non-threatening place in the hopes of decreasing their anxiety should they ever be scheduled for surgery.

In November, we'll be holding our third teddy bear clinic, and our attendance has been rising each year. What started as a children's educational event has evolved into a community gathering. It's an effective way to introduce ourselves, to let the community know that we're there for them and have their care and safety at heart.

Kathleen Lado, RN, BSN, CNOR
Summit Surgical Center
Voorhees, N.J.
[email protected]

Where's the Bedpan?
The risk of post-op vomiting is particularly high with these 6 procedures.

1. Resection of the septal nasal submucosa. Expect up to 20% of all patients to experience nausea after undergoing deviated septum surgery. About 6% will progress to vomiting.

2. Tonsillectomy/adenoidectomy. Up to 4% of these patients will experience nausea and as many as 2% will vomit. Each procedure alone can cause similar results.

3. Rotator cuff repair. Up to 4% of patients experience nausea and 1% will vomit.

4. Lumpectomy. 5% of patients experience nausea and up to 2% progress to vomiting.

5. Laparoscopic cholecystectomy. Up to 5% of patients experience nausea and up to 1% progress to vomiting.

6. Knee arthroscopy. Expect 2% to be nauseous and half that number to vomit.

Single-Vendor Contract Equals Serious Savings
We used to lose money on total hip and knee procedures. Our implant vendors invoiced on an a la carte basis. In some cases, these costs exceeded 30% or 40% of our reimbursement. But since putting a total joint replacement single-vendor contract in place about a year ago, we've been able to reduce our total hip and joint replacement budget by about 28%, saving the center more than $1 million.

Engaging surgeons throughout the process is vital to the successful implementation of a single-vendor contract. We met with surgeons in advance, and held trials for various implants under consideration. We brought several vendors on-site separately, giving physicians exposure to each manufacturer's product.

After each trial — which typically lasted a few weeks — we held a dinner meeting, where surgeons could discuss the pros and cons of each product. The final vote was held at our last dinner meeting, at which point our surgeons had familiarized themselves with products from all of the contenders.

Having a good handle on our reimbursement and cost base was invaluable throughout this process, and is a key for any center considering a sole-vendor deal. Doctors tend to be very data-driven, and want to see if and how single-vendor contracts make financial sense and ultimately improve patient care.

Nancy Laughlin, RN, BSN, CNOR
Nebraska Orthopaedic Hospital
Omaha, Neb.
[email protected]