Gaining Efficiency and Reducing Cost: The Re-design of a Preoperative Screening Clinic

Abstract

Purpose: The purpose of this project was to focus on the redesign of the preoperative screening clinic (PSC) at a 410-bed acute care facility. The process change took place at a healthcare facility where surgical volume has been growing annually since 2011, with an average growth rate of 3% per year. The facility has projected business plans to add capacity for 6 operating rooms in the next three years due to the increased growth. The organization needed the ability to support continued surgical growth prior to the development of adding operating rooms. Understanding the current PSC operations with the need to support future growth, was the motivation for the development of this project to redesign the PSC operations. Methods: A literature review was preformed prior to the development of a plan for change in the PSC. This project is based on using an all registered nurse (RN) group to staff the prescreening clinic for patients needing anesthesia services. The intent was to demonstrate reduced day of surgery cancellations. To complete this process, specific nurse assignments with sequential assembly of the medical chart, and patient information was used. Following approved permissions for use, the Prosci's change management methodology, and the ADKAR model were used to guide the change process. Quantitative data was collected over two separate six month time periods, to compare metrics before and after the change. Results: The z-test was used to determine the significance of the changes made in the pre screening clinic. The results suggest that the changes made to the operational design in the pre screening clinic were significant in reducing day of surgery cancellations. Day of surgery cancellation rate for avoidable causes decreased from 15 cases per month to just two from December 2014 to April 2015. Conclusions: The implementation of the project achieved the goal of decreasing day of surgery cancellations. Additional benefits from the changes implemented included reduced patient wait times in the PSC to an average of less than 15 minutes, and an increased number of patient visits per day by 55%. These changes resulted in an increase in patient satisfaction. Data sources: Data was obtained using Epic's electronic software, which included the Cadence scheduling software. Additional software programs that were used to obtain data were the Kronos time keeping software, and Cisco phone reports. Daily schedules were developed by the manager to coordinate nursing assignments. Researched data sources used included; PubMed, Cochrane Collaboration, CINAHL, and Google Scholar. Key words: pre-screening clinic, pre-admission testing, pre-surgical labs, pre-operative anesthesia consultations, set-up and functioning of pre-anesthesia clinic, cost effective preoperative clinic, design of pre-operative clinic, surgery cancellation rate and the pre-operative clinic.