Study Shows How ASCs Can Cut Cancellations in Half
Cancellations at a pediatric ASC dropped from a rate of 16.8% to 8.8% three months after the ASC made changes that included educating staff and implementing a call log, call script, and checklist, according to a new study.1
The study found that directing preoperative nurses to call patients or their guardians on two separate days improved communication and preoperative screening.1
“It’s an ongoing effort to try to keep cancellation rates down,” says Virginia C. Muckler, DNP, CRNA, CHSE, National League for Nursing Simulation leader and an assistant professor and clinical education coordinator at the Duke University Nurse Anesthesia Program in Durham, NC.
The study, which involved a pediatric ASC, found that uniformity in the message helped with the project’s success.
The call log includes the procedure, who called the family, and additional tracking items.
“Pre-op nurses use the log and document their pre-op assessments and instructions,” Muckler says. “They ask if the parent/guardian has questions, and they notify them that there will be a follow-up phone call one or two days before the day of surgery.”
The log is handwritten, and there is an assessment checklist. Nurses also worked from a script of uniform questions to ask patients. “The script is to make sure items of importance are pretty standard,” Muckler says. “We verify that the surgeon and type of surgery planned are correct.”
“We make sure the parent or guardian knows where to arrive on the day of surgery,” she adds. “They tell them they need appropriate identification and an insurance card, and they make sure they advised them about symptoms.”
If the patient has a fever, there is a question about symptoms and medication. Also, parents and guardians can bring in a comfort item for the child, including a teddy bear or blanket, Muckler says.
Before each surgery, ASC staff will call twice. The first call will be a week or two before surgery, and the second call will be one or two days before surgery. “They start calling at two days prior to surgery in case they are unsuccessful in reaching someone,” Muckler says.
By insisting on uniformity in pre-op calls and questions, the surgery center identified things that otherwise might have been forgotten. These could be instructions that are specific to a particular type of surgical procedure. Without a checklist and script, it’s easy for people to forget to discuss something important.
“Nurses often run the pre-op clinics and are not trained to the specific job they are being asked to do,” Muckler says. “That’s no fault of the nurses; it’s a system issue.”
On-the-job training is a vital part of nursing education.
When Muckler was working on a research project involving nurses, she found that most learned how to perform their jobs through trial by fire.
“They said, ‘I got chewed out a lot,’” she recalls. “I knew we had a problem then.”
The script proved to be very helpful, and the checklist helped standardize the routine, Muckler says.
There is another benefit to the consistent messaging and repeated calls: Patients and their families are more likely to remember what they need to do.
“I think providing them with some follow-up and reiterating these important points were important, also, in lowering cancellations,” Muckler says.
Train staff on new processes like logging calls, documenting what occurred, using scripts, and following up with a second call, she suggests. These training sessions can occur at department meetings or in lunchtime learning sessions.
But it’s important the training is followed by monitoring and data collection, she says. For instance, a surgery center should compare surgery cancellation rates pre-training and post-training. They can collect data on patients’ stated reasons for cancellation.
For example, sometimes surgeries have to be rescheduled by the family because of a personal or work event. Other times, the surgeon has to reschedule. There are rare occasions when the family did not follow the food and medication instructions, and surgery is postponed for this reason, Muckler says.
After the process was implemented, families were better informed about the surgery, and cancellations declined, she adds.
Preventing surgery cancellations is a big issue, and it’s something that must be revisited continually with an ongoing program to educate nurses involved in preoperative phone calls, Muckler says.
“There also needs to be an educational component for patients and family members,” she adds. “We need to make sure we’re educating on both sides.”
REFERENCE
- Lee CM, Rodgers C, Oh AK, Muckler VC. Reducing surgery cancellations at a pediatric ambulatory surgery center. AORN J 2017;105:384-391.
Cancellations at a pediatric ASC dropped from a rate of 16.8% to 8.8% three months after the ASC made changes that included educating staff and implementing a call log, call script, and checklist, according to a new study.
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