Reducing surgical cancellations

Neil Baum, MD

You have a first surgical case scheduled at 7:30. You are leaving the parking lot at 6:45, when you receive a phone call from the operating room that your patient didn't stop their aspirin. The anesthesiologist recommended cancelling the elective surgery. Nothing is more disruptive to a urologist and their schedule than to have surgery cancelled on the day of the intended procedure. The last thing a surgeon or patient wants is for their surgery to be cancelled at the last moment. It's stressful and disruptive to everyone involved. In most instances, these situations can be resolved before the day of surgery. They can be prevented, thus avoiding a costly hole in the urologist's schedule. This article will discuss the use of a simple checklist to avoid cancellations.

Suggestions when scheduling the case:

Contact the patient 7-10 days before the procedure by phone, e-mail, or text as a reminder of the date of surgery, the hospital, and the time to arrive at the hospital\ATC

Be certain that insurance approval has been received. I recommend that this be in writing, as verbal approval may result in the doctor, anesthesiologist, and hospital not getting paid, and the patient receiving an unexpected bill. Even if the surgical result is excellent, a patient receiving a bill creates an unhappy patient. It is the responsibility of the practice to be certain that approval and authorization have been obtained before the surgery.

If your operation requires a medical device or equipment brought to the operating room, contact the representative, and give them the date and the time that the surgery is scheduled. Ensure the representative arrives at the facility before the procedure starts.

Notify the representative of any special needs you may require for the procedure.

10 -14 days before the procedure:

Make sure that all consultations have been completed and notes from the consultant are on the chart, copies have been received by the hospital/ATC and reviewed by the anesthesiologist 48-72 hours before the procedure. If there is a problem with the facility misplacing or losing the reports and results, then bring a folder with the necessary documents with you to the OR.

Check all the lab work (glucose and potassium) and be certain that anything abnormal has been reviewed and approved by the anesthesiologist.

Review EKG and CXR for any abnormalities and requests for additional views, i.e., nipple markers.

If patients are on aspirin and/or anticoagulation medications, ensure they have been discontinued 7-10 days before the surgery or that you plan to use a "bridge" approved by the PCP, internist, or cardiologist.

Pre-op visits with the facility have been scheduled and completed.

1-3 days before the procedure:

Make sure the patient has prescriptions filled for post-operative antibiotics and pain medication before the surgery to avoid pain and discomfort after the procedure.

Nurse or medical assistant contacts the patient and reminds the patient to avoid food or fluids after midnight the night before surgery.

Recommend a laxative or suppository on the day before the procedure, so constipation will not be an issue post-operatively

Post-op visits are scheduled before the surgical procedure

The nurse or medical assistant makes sure all questions by the patient have been answered, and if necessary, have the surgeon answer any additional questions the patient may have

And most important of all, make sure the consent is signed for the practice AND the hospital, and that the facility has a copy of the consent on the chart. I suggest that you bring a copy of the consent with you on the day of surgery, "just in case" the hospital misplaces the consent you have faxed or sent to the hospital or the ATC.

Afternoon before procedure:

The medical assistant or nurse calls the patient and reminds them of the importance of no food or fluids after midnight, and the time they are to report to the hospital or ATC.

Lagniappe*- or after the procedure

It is such a nice gesture and so very appreciated by patients if the doctor or the nurse calls after the surgery to check on the patients and answer any additional questions. I suggest telling the patient approximately the time that someone from the office will call so that they are not on the phone.

Bottom Line: To avoid the last thing anyone, i.e., patient and doctor, wants is for their surgery to be cancelled at the last moment. It's stressful and disruptive to everyone involved, leading to an unhappy doctor and patient. No matter how hard you try to prevent it, some surgeries will be cancelled due to lack of paperwork, insurance refusals, or even human error. The job of the practice is to get those patients back in the system and rescheduled for surgery as soon as possible.

*Cajun for “something extra” or thirteen pastries as the baker’s dozen

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.