Five Ways to Reduce Surgical Delays
By Brian Dawson, MSN, RN, CNOR, CSSM
Delays and cancellations are not uncommon in the perioperative setting when failures with communication or hand-offs occur, when patient pre-assessments aren’t completed in time, or when clinicians and OR space is not available.
When perioperative delays do occur, everyone suffers—if the surgery is cancelled, the hospital loses revenue and the patient loses faith in the hospital’s ability to provide adequate and timely care. If the surgery is not cancelled, important health information for the patient could get lost in the shuffle and put the patient’s safety at risk.
Delays in treatment have topped the Joint Commission’s list of most commonly reported causes of sentinel events for 2013 and 2014, pushing aside wrong site surgery and retained surgical items as the top culprit for patient harm. Today’s healthcare consumer expects more from OR providers, and OR leaders should expect more from every stakeholder involved in coordinating surgery. Hospitals won’t survive if surgical services leaders allow delays in treatment that lead to cancellations, lost revenue, and increased risk for patient harm, especially if urgent and emergent surgical care is delayed. It is the responsibility of every OR director to build processes, provide staff and resources, and instill a culture where communication and coordination is the responsibility of every person who touches patient care to meet the most important goal— to be there for the patient.
Dedicate Time and Resources to Prevent Delays
The five most common reasons for OR delays and suggested solutions to prevent these delays
Problem: Paper chase delay—missing preoperative paperwork from a patient’s file such as an outdated history and physical or a missing consent form
Solutions: Create a pre-procedure testing unit in which clinicians, including advanced practice nursing and anesthesia care providers, interview the patient, coordinate paperwork collection and provide a complete health work-up for the patient 72 hours before surgery. This team must communicate closely with primary care and specialty care physicians also caring for the patient and with the OR director, surgeon, and anesthesia provider to ensure everything is in place the day before surgery. Pre-procedure testing unit leaders should meet monthly with all surgeons and their office staff to maintain communication, refine coordination of the pre-procedure and scheduling process, and help orient new office staff to the process.
Problem: Inadequate patient work-up—the patient does not receive a sufficient health evaluation by a specialist to the satisfaction of the anesthesia provider, particularly when a patient has comorbidities such as cardiac or pulmonary issues
Solutions: Established coordination through the pre-procedure testing unit creates the opportunity for patient assessment at least 72 hours prior to surgery. This also provides enough time for medication assessment in case a patient is taking a medication such as a blood thinner that needs to be stopped within a safe time frame before surgery. If a patient does not have a primary care physician, the testing unit care providers can complete the work-up and connect the patient with a specialist, such as a cardiologist, if comorbidities are identified.
Problem: Insufficient patient education—the patient eats, drinks or takes a medication that is contraindicated for surgery
Solutions: Preoperative patient education provided by the pre-procedure testing unit providers creates an opportunity for dedicated education and communication with the patient and family to ensure the patient arrives ready for surgery.
Problem: Insufficient OR preparation—equipment or consumable supplies are not available at the time of surgery
Solutions: OR leaders must ensure that each surgical specialty has an experienced nurse over that specialty who works well with the surgeon to coordinate supply needs through a preference card system. This relationship creates the opportunity for dialogue and planning several days before surgery to prevent double-booking a similar procedure that requires the same equipment at the same time.
Problem: Last-minute schedule changes—urgent or emergent surgical cases cause delays with the elective surgery schedule
Solutions: Set aside an OR room and schedule slot (20% of a block) that is dedicated for emergent or urgent surgical cases. You need to make sure your OR schedule remains as efficient as possible. By building in the space and time for urgent and emergent cases, you can leave your elective schedule blocks alone. Take a close look at block utilization as part of the process to refine scheduling and prevent after-hour add-ons that increase staffing costs.
Educate and Empower All Stakeholders
Implementing these solutions requires a clear understanding of the business operations of running your OR. The OR is the biggest business within the hospital, and implementing these solutions to delays is vital to maintaining the financial health of perioperative services by eliminating cancellations and ensuring solid revenue. The OR director has the power to share this type of financial rationale with their C-Suite leaders to get the green light for investing in strategies such as establishing pre-procedure testing units. On the operations side, the OR director is in the perfect position to empower managers and frontline staff to maintain a culture where open communication, effective coordination, and forward thinking is part of daily practice.
Brian S. Dawson, MSN, RN, CNOR, CSSM, CEO and President BD Perioperative & Healthcare Consulting, LLC, Denver, Colorado
The first Afro-American male Nurse Corps Officer to command a naval hospital, Brian earned his Bachelor of Science in nursing from American University in Washington, DC. Upon graduation, he was commissioned as an ensign in the US Navy Nurse Corps in 1983. Brian served in various positions, including SPD Manager, OR Department Head, and Director of Surgical Services at multiple facilities. In 1997, Brian graduated with honors from Old Dominion University in Norfolk, Virginia, with a Master of Science in Nursing Administration/Leadership. He went on to serve as the COO of a naval hospital at the largest Marine Corps base on the East Coast and as the CEO of the largest overseas naval hospital, in Okinawa, Japan. He finished his distinguished 28-year naval career as the Chief of Staff for the 36th Navy Surgeon General. Upon retiring from the Navy, Brian served as the Vice President of Surgical Services for Salem Hospital in Salem, Oregon, and as Director of Surgical Services at St Anthony’s Hospital in Lakewood, Colorado. He currently is the owner, CEO, and President of BD Perioperative & Healthcare Consulting, LLC, in Denver, Colorado.