A GOOD START Don't underestimate the value of preparation and explanation.

First impressions are everything. For surgical facilities, first impressions take a lot of preparation in the time before each patient's procedure to ensure day-of-surgery success. Here are some practical solutions for smoothing out your pre-admission process, and reducing delays and canceled cases.

Online forms can avert chaos
Do you remember winter? Jen Watson, BSN, the pre-op/PACU manager at Charlotte (N.C.) Surgery Center does. In the thick of the record-setting snow and ice storms, she and her staff experienced a 2-day closure, the sort of contingency that can wreak havoc on a busy surgery center.

"The ripple effect of an unexpected closure can last days as surgeries are rescheduled and nurses are left scrambling to play catch-up on pre-admission calls," she says. Re-opening is typically a chaotic event. Staff must triage patients upon their arrival, going over their medical histories on the day of surgery instead of a couple of days beforehand, potentially pushing their surgical start times back hours or canceling them entirely.

But it was "smooth sailing" at Ms. Watson's center, even with 44 cases scheduled. "All surgeries occurred without delay, which would not have been possible had we not brought our pre-admissions process online," she says. "We re-opened without missing a beat."

The online pre-admissions portal the center implemented let nurses access the system, remotely and securely, via their home Internet connections to keep the center's upcoming schedule on track. During their snow days at home, they could review patient-supplied pre-op histories for completeness, contacting patients for more information and inputting it into the system. Anesthesia providers and surgeons were also able to review the histories for any necessary medical clearances.

Even on non-snow-days, however, giving your patients the opportunity to fill out their forms online, on their own time, well before surgery, offers advantages. "We still call every patient to verify the time they're supposed to be here, to go over the details and specific instructions," says Ms. Watson. "But everything is much more efficient when you don't have a nurse on the phone taking 20 minutes with each patient to go over the questions and taking down their medications list. And we tell them, 'If you have Internet access, you don't have to be on the phone with me for however long it takes.'"

ON THE LINE A good relationship with physicians' schedulers is key.

People pave the way
The first contact your patients are likely to have with your center is through their (and your) physicians. Among other things, that's where they'll get their initial information on what to expect and what's expected of them in advance of their procedures, which primes them (and you) for the day of surgery. So it's to your benefit to keep in touch.

"You need to have a good rapport with your physicians' offices, and to stay abreast of their doings," says Pam Ertel, RN, BSN, CNOR, RNFA, CASC, FABC, administrative director of the Reading Hospital SurgiCenter at Spring Ridge in Wyomissing, Pa. To facilitate this relationship, she recommends that the staff who coordinates with physicians' schedulers "should be personable. In fact, it should be one person. There's no better way to boost efficiency than for them to get to know one another," to be able to ask about how a family member's doing or chat about weekend plans. When you make visits to physicians' offices, bring your scheduler along.

Another way to build a relationship with your physicians' office staffs is to invite them over for workplace socializing. "We're planning to schedule quarterly events at which schedulers can meet our whole staff," says Ms. Ertel. "We'll review changes on our forms and insurance contracts, but we'll also feed everyone, hold a raffle drawing, even offer massages. Students at local massage schools need experience hours to get their certifications, so we'll invite them over to do chair massages." Staff get to relax while students get their time in: the definition of a win-win.

A couple of additions to your staff can also help to increase the efficiency of patient intake. Ms. Ertel's center created the position of medical records coordinator to pore over pre-admission charts and confirm that all necessary information and test results are there. "They don't need to be a nurse to get the pieces together," she says. In fact, an investment in this hire saves you the expense of assigning a nurse to handle the task. In the business office, a pair of insurance verifiers "are the busiest people in our facility," she says. They spend the day calling insurers to determine each patient's co-pays and deductibles, and then send each patient a letter detailing his or her financial obligations ahead of their surgeries.

When putting your people to their ideal use, don't overlook the efficiency of enlisting the patient. "We have a policy of no-patients-waiting-in-the-lobby," says Ms. Ertel. "We give each arrival a clipboard with the printout of the pre-admission forms and ask them to verify that everything is correct." Instead of having your front desk staff take each patient into a private area and go over the information with them one at a time, while the rest wait, you can have all of them reviewing and correcting at once, she says.

When's the best time to verify patients' pre-admission charts and insurance information? The sooner the better.

"We review charts at least 2 days in advance," says Joyce Mackler, RN, MSN, manager of the Seaford (Del.) Endoscopy Center. "It could be a couple of weeks since they've last been in their physician's office, so we call to ask whether their health has changed since then, or if there's anything new that is not in our chart."

Make this call before the patient begins the bowel prep, she says. An unexpected cancellation after that point would be highly inconvenient for both facility and patient.

"Patients don't always understand their insurance, and that can lead to a lot of cancellations," she says. As soon as a case is scheduled, if time allows, her center's business office notifies patients via postal mail of their co-pay and deductible responsibilities as well as the available payment plans.

To get a head start on the day of surgery, you might even consider starting your check-in process a day or 2 before. "If you fall behind a couple of patients on the schedule, you're dead in the water," says Ms. Mackler. "So for the first 2 patients of the day, we'll confirm their pre-admission forms and check for additional information on the phone ahead of time, as opposed to on the day of. That's a good start."

Informed patients are satisfied patients. So when they arrive on the day of surgery, be sure your staff fully explains the steps of the process. "Open the window with a pleasant greeting and service right away, and let them know what papers they're signing," says Ms. Mackler. "Then keep explaining. What's next, who they're being handed off to, throughout the process. That's very important, the 'My name is, I'm here to do this.'"