◙ TIME MANAGEMENT Darin Prescott, MSN, MBA, RN, CNOR, CASC, says some delays are inevitable, but you can track and address tardiness trends.

Completing all pre-admission screenings 3 days before scheduled surgeries is an attainable goal that improves scheduling efficiencies and surgical safety, says Darin Prescott, MSN, MBA, RN, CNOR, CASC, patient care manager at Mayo Clinic Health System in Mankato, Minn.

"Optimal pre-op evaluations should clear patients for elective procedures, but also involve measures that prepare higher risk patients for surgery," he explains.

What prevents effective and efficient pre-op screenings? Mr. Prescott says leaders don't enforce guidelines when needed paperwork isn't in on time, there's frontline resistance to change and communication issues — goals and messages are inconsistent — prevent capitalizing on opportunities to eliminate inefficiencies and overhaul ineffective protocols.

At the Mayo Clinic, Mr. Prescott ran a quality improvement program that ensures documentation for all elective cases was submitted to a pre-admission facilitation office by 8 a.m., 3 business days before surgery. The pre-admission nurse then sends completed charts for anesthesia review. If information is incomplete, the nurse confers with the OR scheduler to take the patient off the surgery grid. Pre-admission staffers notify the surgeon's office that the patient is no longer scheduled for surgery. If the needed information arrives and anesthesia review is completed before the scheduled case, the patient may get back on the schedule if a spot is available.

Some delays are inevitable, says Mr. Prescott, but you can certainly track why cases are delayed, see if trends develop and address them so disruptions to the surgical schedule don't become the norm. He presented a simple Excel spreadsheet that shows when cases are scheduled to begin, and when they actually do. Cases that start on time are marked green, while procedures that are delayed are marked red, and a reason is noted. "We'd see if pre-op nurses are having trouble starting IVs, or perhaps the issue is masking some other problem that needs to be addressed," explains Mr. Prescott.

His initiative laid down pre-admission law and led to numerous benefits: the elimination of day-of-surgery testing, more on-time starts, fewer case cancellations for medical reasons, complete pre-op testing and documentation, and improved teamwork and collaboration among the perioperative team.