Optimizing Patient Services with Electronic Surgery Scheduling

Effective surgery scheduling is a major component of any hospital. Unfortunately, operating room (OR) management can be a logistical nightmare. Rooms have to be secured and housed with the right equipment for specific surgeries. Specialized equipment, if needed, has to be acquired, and allergy-related precautions have to be prepared. Without accurate scheduling, a delayed or mismanaged surgery can result in the net loss of tens of thousands of dollars. If a planned surgery doesn’t take place for some reason, equipment that is pulled out of storage has to be stripped down, re-sterilized, and re-packaged, and a last-minute cancellation or ‘no show’ may result in additional costs for unnecessary staffing.

These criteria were particularly applicable to a Pennsylvania medical center located near Harrisburg. Approximately 450 surgeries are performed at the facility every week—almost 100 per day. To accommodate demand, the medical center has twenty operating rooms, one of which is an outpatient surgery area. Twenty-two departments throughout the hospital can schedule surgeries.

In an effort to streamline the intricate and often complicated surgery scheduling process, the medical center determined that they could improve patient services by transitioning from manual paper scheduling processes to electronic. In doing so, they transformed their patient services and realized an ROI that went well beyond monetary benefits, including:

• Elimination of lost, misplaced, or duplicate scheduling forms
• Elimination of paper and faxes
• Increased patient and department satisfaction
• Decreased potential for lost revenue
• Improved accountability with auditing
• Creation of a single form for all of their clinics
• Virtual elimination of follow-up phone calls
• Better communication between departments

Challenge #1: Streamlining paper processes to achieve efficiency

In their previous manual process, approximately one hundred faxes were filled out and faxed every day; as a result, the hospital went through three reams of paper every week. The Systems Analyst at the medical center recalls, “After completion, the surgery scheduling form was faxed to two locations: Operating Room (OR) Schedules and Inpatient Access. At the OR Schedules location, tasks were delegated that resulted in the overall management of the operating rooms. A copy of the Surgery Schedule Form was stored in OR Schedules.”

He continues, “Inpatient Access would also store a copy of the Surgery Schedule Form. This area is responsible for creating a number that serves as a unique identifier that pertains to a patient’s specific visit. Inpatient Access is also tasked with verifying insurance and pre-certifying procedures prior to surgeries, as well as reserving beds for post-op tests, procedures, recovery, and post-surgical hospital stays.”

Challenge #2: Enabling faster and more accurate scheduling by automating processes

Under the paper-based system, scheduling was fraught with potential for miscommunication. Twenty-two different scheduling forms were used, depending on the department of origin. The Systems Analyst explains, “If, for some reason, a patient could not make a surgery date, the original scheduling form would be revised. This usually involved scratching out and overwriting the non-pertinent information with updated information. Revised forms were required any time that changes were warranted regarding surgical equipment, procedures, or dates. In these cases, the new procedures would have to be pre-certified again. Revised scheduling forms were sent to OR Schedules, Inpatient Access, or both locations.”

A lost or misplaced fax could result in serious consequences. Patients could potentially show up for surgery and not have a room booked. If pre-certification information is changed or lost, the hospital could face payment problems. OR time could be booked; but patients could be unregistered. Post-surgery rooms could be unavailable. If the fax machine were to run out of toner, phantom faxes — faxes with no information — could be received, creating scheduling confusion.

The Systems Analyst recalls, “Revised forms were the norm, not the exception. It was not unusual to have as many as fifteen revisions on a form. Revised copies were stapled to the originals, and were often difficult to read.” As the revisions piled up, so, too did the paper. Surgeries were often scheduled eight months in advance, leaving plenty of time for scheduled surgeries to be revised. The Systems Analyst continues, “Procedurally, the system had considerable potential for error. Every individual procedure was documented by three sheets of paper, any of which could have had revisions. With paper, there was also no accountability and no standardization. Every clinic had its own process for filling out forms, reconciliations, and revisions. We realized that by simplifying the Surgery Scheduling Form, we could maximize efficiency and circumvent potential problems.”

Improving patient services with automated workflow

Using the hospital’s electronic document management system, the medical center was able to create an XML form that simplified and unified their surgical scheduling processes. The medical center stores EOBs, checks, credit card receipts, payment receipts, and anything else that is associated with a hospital or physician payment in its electronic repository. ABNs (Advanced Beneficiary Notices) and data that is collected for medical studies are also stored in the repository. Because the surgery scheduling form integrates with the document management system, the software gives the hospital the ability to tie automation into the scheduling processes by using electronic workflow.

The medical center was able to create a unified form that significantly simplified their scheduling processes. The hospital currently uses one standard form, with a few variations for specialized departments such as plastic surgery. The form is integrated with an OR equipment list, CPT codes, anesthesia types, locations, and other factors. The Systems Analyst says, “We eliminated blank fields in the form to simplify processes for end-users. Wherever possible, we populated the form with pull-down lists that integrate with SQL databases in the background. This helps to unify processes. To ensure verification, Description, Procedure, CPT code, and ICP9 codes all have to match. Any discrepancies in the verification process are checked.”

Enabling faster and more accurate scheduling with workflow

The Systems Analyst continues, “The scheduling form is integrated with automated workflow. That way, as soon as a scheduler completes a form and submits it, it goes to the appropriate queue, which is closely monitored.”

Surgeons appreciate the speed and precision of the new system. That way, if they determine that they want to shuffle their personal schedules on any given day, they have an accurate idea of their personal agendas.

The Systems Analyst recalls, “Since going live with the electronic form in July 2006, we’ve scheduled an average of 471 cases per week. In that time, we’ve had no lost forms. A scheduler completes and submits a Surgery Scheduling form online, then the OR schedulers get a job in their Workflow Queue. Inpatient Access or OR Schedules receive the correct job in their workflow queue. A single copy of the form is stored in the repository.”

He elaborates, “As a result of the surgery scheduling system, we have simplified what was formerly a complicated process, resulting in the elimination of lost forms and increased patient and department satisfaction. In addition to increasing communication between departments, we have improved accountability with auditing.” He summarizes, “Our utmost priority is patient care and satisfaction. Our document management system has helped us to provide superior service and exceptional efficiency.”

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