5 Strategies to Minimize Damage from Same-Day Cancellations

A same-day surgery cancellation can disrupt an entire day's schedule in an ambulatory surgery center. Not only does that patient's procedure get canceled, but an otherwise full surgery slot goes empty, says Rose Eickelberger, MS, RN, director of surgical services at Summit Surgical Center and Beacon West Surgical Center in Cincinnati, Ohio.

"The bottom line is that it does result in a loss of revenue for that day," she says.

Out of the 1,716 procedures performed at Ms. Eickelberger's two centers in the first half of 2011, there was only one same-day cancellation. That low rate is typical in her centers, Ms. Eickelberger says. She offers five strategies her centers use to reduce the number of same-day cancellations and minimize the damage when cancellations are unavoidable.

1. Conduct pre-admission screening. Before every procedure, a nurse calls the patient and completes a health screening. The screening also includes information about the patient's history and physical, conducted by the primary care physician prior to surgery. Ms. Eickelberger's staff members have found their screening process provides more detailed information on the patient's health than the history and physical records may indicate, she says. This screening can prevent cancellations due to unknown health issues, such as a heart arrhythmia, before the patient comes into the center. The day before the procedure, another nurse calls to do one final reminder about the time the patient should arrive and any preparation necessary.

2. Ask anesthesiologists to review patient charts a few days before the procedure. Anesthesiologists should review patient charts before the day of the procedure to flag any possible concerns, such as cardiac issues, as well as develop a plan for that patient. Doing this before the day of surgery allows staff to prepare for complications in advance, Ms. Eickelberger says.

3. Enlist a patient advocate. A patient advocate serves as a liaison between patients and healthcare providers. Ms. Eickelberger's centers enlist a patient advocate who calls to ensure patients understand their financial obligations. It's this level of communication with the patient before the procedure that keeps the cancellation rates low. Ms. Eickelberger says patients have commented on how many calls they received prior to their procedure.

"They get called at least three times from us just to make sure everything is ready to go for them," she says.

4. Make it easy to reach the patient on the day of surgery. Ms. Eickelberger says her staff asks every patient for a number where they can be reached on the day of the procedure in case there are any changes. This allows staff to rework the schedule as things happen that day, such as a cancellation or a surgeon getting ahead of schedule.

"As soon as we know about a cancellation, we start rearranging the schedule," she says. "We do not delay the surgeon at all. We don't want to have gaps where staff is waiting around."

5. Allow for flexible time.
The centers also allocate flexible time to make it easier to rework the schedule. Ms. Eickelberger says every day at her centers is different. On some days, surgeons are done early, and on others, the staff works longer days. The important thing is to ensure the staff is prepared to anticipate a changing schedule.

"We flex our schedule based on the surgeon's need," she says. "Day to day, our surgery centers and staff flex their work schedule based on the needs of the ASC's surgery schedule."

Related Articles on ASC Turnarounds:
30 Statistics on Pain Management in Surgery Centers
10 Points on Ophthalmology in Surgery Centers
How to Sell Your ASC: Thoughts From ASCOA's Luke Lambert

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