Physicians at Allied Anesthesia in Orange, Calif., have been working for the past year to perfect a "Patient Ready Protocol" to improve pre-op coordination, eliminate unnecessary tests and reduce the number of surgical delays and cancellations.
Our group's efforts have resulted in significant improvements in the pre-op process for patients at Children's Hospital of Orange County and St. Joseph Hospital in Orange where Allied Anesthesia provides pediatric and adult anesthesia services.
JoAnn Perucho-Ladrido, clinical coordinator for the pre-admission and pre-op holding units at St. Joseph Hospital, said that before "PReP" was instituted, only 22 percent of patient charts were complete with the necessary surgical requirements prior to the day of surgery. As a result, surgeries were delayed while staff scrambled to track down paperwork, draw blood and perform EKGs and chest x-rays on the day of surgery.
When a pilot protocol was implemented in February 2012, the percentage of complete patient charts more than doubled from 22 percent to 51 percent in the first month. As of December, they were up to 72 percent, Ms. Perucho-Ladrido said.
"On the day of surgery, the nurse looks at the chart and knows exactly what's in there and what's missing," Ms. Perucho-Ladrido said. "It really helps streamline the process and, at the same time, provides our patients a positive surgical experience."
Ms. Perucho-Ladrido conducts a monthly audit to determine the reasons for incomplete charts and reports her findings to the medical executive and operating room committees.
"Our two biggest challenges right now are missing consent to read orders and missing pre-op tests," she said.
The protocol has generated a lot more education and communication between the hospital and the surgeons' offices. Ms. Perucho-Ladrido provides updates on their performance and assistance in increasing compliance to the PReP protocol.
"We are building relationships with them," she explained. "When you have collaborative relationships, it's easier to work toward a common goal that satisfies everyone."
Manoj Kulkarni, MD, an Allied Anesthesia physician, added that feedback from surgeons, who no longer have to deal with pre-op details, has been very positive.
"We want to offer a one-stop shop," Dr. Kulkarni said. "Once the surgery is scheduled, our ultimate goal is to take care of everything else from there."
Dr. Kulkarni has spent several years developing web-based software that will coordinate all of the patient's information such as health history, lab results and other basic screenings into one electronic record that is available several days in advance of the surgery.
As a result, patients will have a clearer understanding of what all they need to do, like when to start and resume taking certain medications and when they need to show up to the hospital.
Another benefit of the software is that once the information is entered into the system, the computer issues specific guidelines on what tests are required for the specific patient and the specific surgery.
"The evidence is out there that by doing the right tests for the right patients and giving them the right instructions, patients will have fewer infections, less complications from surgery and shorter stays in the hospital," Dr. Kulkarni said. "These are all major benefits."
Paul Yost, MD, is an anesthesiologist with Allied Anesthesia as well as director of cardiac services at St. Joseph Hospital and co-director of pain management at Children's Hospital of Orange County. He received his medical degree from Baylor College of Medicine and completed residencies at the University of California, Los Angeles and the University of Miami.
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Our group's efforts have resulted in significant improvements in the pre-op process for patients at Children's Hospital of Orange County and St. Joseph Hospital in Orange where Allied Anesthesia provides pediatric and adult anesthesia services.
JoAnn Perucho-Ladrido, clinical coordinator for the pre-admission and pre-op holding units at St. Joseph Hospital, said that before "PReP" was instituted, only 22 percent of patient charts were complete with the necessary surgical requirements prior to the day of surgery. As a result, surgeries were delayed while staff scrambled to track down paperwork, draw blood and perform EKGs and chest x-rays on the day of surgery.
When a pilot protocol was implemented in February 2012, the percentage of complete patient charts more than doubled from 22 percent to 51 percent in the first month. As of December, they were up to 72 percent, Ms. Perucho-Ladrido said.
PReP
Under the protocol, a nurse reviews each patient's chart two business days before surgery to make sure there are no discrepancies between the consent to read orders and the OR schedule and that all the required tests have been performed. If there is a problem, the nurse follows up with the physician or consults with an anesthesiologist to resolve the issue before the day of surgery."On the day of surgery, the nurse looks at the chart and knows exactly what's in there and what's missing," Ms. Perucho-Ladrido said. "It really helps streamline the process and, at the same time, provides our patients a positive surgical experience."
Ms. Perucho-Ladrido conducts a monthly audit to determine the reasons for incomplete charts and reports her findings to the medical executive and operating room committees.
"Our two biggest challenges right now are missing consent to read orders and missing pre-op tests," she said.
The protocol has generated a lot more education and communication between the hospital and the surgeons' offices. Ms. Perucho-Ladrido provides updates on their performance and assistance in increasing compliance to the PReP protocol.
"We are building relationships with them," she explained. "When you have collaborative relationships, it's easier to work toward a common goal that satisfies everyone."
Manoj Kulkarni, MD, an Allied Anesthesia physician, added that feedback from surgeons, who no longer have to deal with pre-op details, has been very positive.
"We want to offer a one-stop shop," Dr. Kulkarni said. "Once the surgery is scheduled, our ultimate goal is to take care of everything else from there."
Dr. Kulkarni has spent several years developing web-based software that will coordinate all of the patient's information such as health history, lab results and other basic screenings into one electronic record that is available several days in advance of the surgery.
As a result, patients will have a clearer understanding of what all they need to do, like when to start and resume taking certain medications and when they need to show up to the hospital.
Another benefit of the software is that once the information is entered into the system, the computer issues specific guidelines on what tests are required for the specific patient and the specific surgery.
"The evidence is out there that by doing the right tests for the right patients and giving them the right instructions, patients will have fewer infections, less complications from surgery and shorter stays in the hospital," Dr. Kulkarni said. "These are all major benefits."
Paul Yost, MD, is an anesthesiologist with Allied Anesthesia as well as director of cardiac services at St. Joseph Hospital and co-director of pain management at Children's Hospital of Orange County. He received his medical degree from Baylor College of Medicine and completed residencies at the University of California, Los Angeles and the University of Miami.
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