Keep the Surgical Schedule on Track

Communication apps and online management software improve overall efficiencies by helping to properly prepare patients for surgery and making sure cases start on time. Read on to find out how two clinical leaders used software solutions to ensure surgeries begin as planned, and improved staff and patient satisfaction in the process.

Robyn Washington, MBA, BSN, RN, CNOR, a clinical nurse lll at Houston Methodist at The Texas Medical Center, realized a lack of standardization in clinical practice was affecting almost every domain of nursing, from the pre-op assessment to the overall patient experience. A collaborative team of healthcare professionals from diverse fields created a management and process improvement committee with the goal of developing a strategy that would optimize the episode of care. "The committee included surgeons and staff from the pre-admit testing center to address patient engagement, and to figure out how to enhance patient care before and after surgery," says Ms. Washington.

The committee chose to employ a digital care navigation and data collection system in order to increase standardization of practices and decrease inefficiencies. The technology simplifies patient communication by sending vital information and updates through a mobile app or via emails or text messages. "Patients receive educational content, care reminders and pre-op screening questions," says Ms. Washington. "Having this information readily available improves their understanding of how to prepare for procedures and recoveries, a factor that leads to fewer cancellations and decreases lengths of post-op stays."

Technology keeps the patient engaged during the entire surgical process.
— Robyn Washington, MBA, BSN, RN, CNOR

Before the medical center employed the digital communication platform, patients would receive educational information during their pre-op assessments in PowerPoint slides, brochures or handouts. Ms. Washington observed that many patients were overwhelmed with the amount of information they were receiving, and ended up leaving with more questions than answers. With the help of technology, patient education is enhanced because their questions get answered at their own pace and convenience.

Digital platforms let you educate, monitor and communicate with patients in real time, points out Ms. Washington. "Technology keeps patients engaged during the entire surgical process," she says. "We send customized videos from surgeons as well as educational emails, which help to ensure patients are taking the proper steps to prepare for surgery and are therefore less likely to have their cases canceled."

Ms. Washington says patient satisfaction, engagement and understanding were higher than expected after implementation of the digital communication efforts: 92% of patients said the automated text messages, emails and app notifications improved their understanding of the care they would receive. The facility also received 35% fewer calls, emails and questions from patients before their procedures.

No one likes to wait, especially patients scheduled for surgery first thing in the morning. Matthew R. Lucas, BSN, RN, CNOR, clinical staff leader at Monroe Carrell Jr. Children's Hospital at Vanderbilt in Nashville, says delayed cases make nervous patients even more anxious, especially if they've been fasting for hours before their scheduled procedures.

Delayed starts to the first cases of the day can throw off the rest of the schedule and impact team morale. "When delays begin to stack up, staff end up having to stay late, which leads to burnout and frustration," says Mr. Lucas.

He realized that in order to ensure the first cases of the day start on time, his staff needed to determine common causes of delays. They created a multi-disciplinary group consisting of anesthesiologists, surgeons and staff members from the PACU and operating rooms to find out.

The group soon realized that the hospital's new EMR system had a shortcoming: Trends in case delays couldn't be identified because staff was documenting that procedures didn't start on time, but couldn't indicate specific reasons for the delays. "We were unable to provide accountability or resources because we didn't have accurate delay codes," says Mr. Lucas. "The staff would simply list 'other' as the reason for delayed starts."

This led to diligent work with the facility's IT department to come up with accurate delay codes such as surgeon unavailable and incomplete pre-op paperwork. "We can now see trends and rectify the issues," says Mr. Lucas.

For example, if a surgeon was unavailable at the scheduled start time of a case, Mr. Lucas can investigate why. Was the surgeon occupied with another patient or was it because they were late in arriving? "Having this information at our fingertips enabled us to improve our on-time case starts across ORs," says Mr. Lucas.

The improved electronic documentation has also helped the facility refocus its resources and improve overall efficiencies. "It tracks a lot of data  - case volumes, start times and admission rates - which helps us gain insights into areas that need improvement," says Mr. Lucas.

At the beginning of the initiative, Vanderbilt Children's first case on-time starts averaged 46%, compared with the national average of 63% noted by the Children's Hospital Association. After the digital documentation of reasons for delays, the facility's rate of first case on-time starts is more in line with the national average. Utilizing technology to its maximum potential has improved the hospital's efficiencies, and staff and patient satisfaction scores are way up. The results clearly show the benefit of relying on software solutions to solve issues that impact the surgical schedule. OSM