From: A new pathway for elective surgery to reduce cancellation rates
Time period | Clinical pathway before intervention | Intervention | Intended improvement |
---|---|---|---|
Before consultation at outpatient clinic | Referrals for elective surgery were sent to various departments. Each surgical department had their own lists of patients who were waiting for a consultation and surgery. | One electronic reception for all referrals for elective surgery. | Waiting list transparent across departments. More unified handling of referrals. |
Consultation at outpatient clinic | Patients cleared for surgery were sent home without an appointment for surgery and without a medical pre-assessment. | New routine that clarified the allocation of work between surgical and anesthesia personnel with regard to clinical pre-assessment of the patient. | Earlier and improved medical pre-assessment is known to reduce cancellations. |
Patient participation in planning date for surgery may improve patient satisfaction. Early notice of date for surgery is suggested in the literature as a factor that might reduce no-shows. | |||
Medical pre-assessment was done the day before surgery. | |||
Patients participate in planning the date of surgery and obtain the actual appointment while at the outpatient clinic. | |||
Consultation at drop-in anesthesia outpatient clinic at day-surgery center | Not applicable | A new day-surgery center is created within the existing premises. | Improved information flow between surgical and anesthesia personnel may improve the quality of the clinical process. |
Patients cleared for surgery proceed straight to the laboratory for blood sampling and medical pre-assessment at newly established drop-in anesthesia outpatient clinic at the day-surgery center. | |||
The surgeon’s considerations are written immediately after the consultation so that anesthesia personnel have the preoperative information during the preoperative assessment. | |||
Preparing for surgery | Letter to patient with appointment for surgery. Patient had no influence on appointment time. | Patient receives phone call from hospital 2 days prior to surgery to ensure that he is fit and ready. | Patients get a reminder of their appointment, which can reduce cancellations due to no-shows. If the patient is temporarily ill, then there is time to call a new patient and avoid a cancellation. |
Limited planning between different surgical departments. Each surgical department had their own surgery program that basically was a text file. | One common electronic surgery planning system for all departments. Designated coordinator supervises the planning process between departments. | ||
One common overview for all departments allows better coordination and planning and might lead to more operations per day. Cancellations caused by facility shortcomings, such as double-booking of the same equipment, may be reduced. | |||
Surgery | Patient showed up for pre-assessment the same day or one day in advance of the planned surgery. Routines varied between departments. | All patients scheduled for elective surgery are received at the day-surgery center. New standardized routines are implemented for pre-surgery preparations. | Centralizing all surgery patients and standardizing routines may reduce variations in the clinical process and thereby improve quality. |
After surgery | Patients discharged from different departments with different routines. Discharge letter was not always in hand when the patient left. | All day-surgery patients are discharged from the day-surgery center through new standardized routines. | |
Discharge letter is written and given to the patient before discharge. |