Session: Automate to elevate—Streamlining pre-, postoperative processes for better outcomes in ASCs

Editor's Note

Pairing short, human-led preoperative videos with structured postoperative texting streamlines workflows without sacrificing clinical touch at ambulatory surgery centers (ASCs), said Austin Cheng, CEO of Gramercy Surgery Center in New York City, and Tracy Hoeft-Hoffman, MSN, MBA, RN, CASC, administrator of Heartland Surgery Center in Nebraska, at the 2025 OR Manager Conference.

Chang said his two four-OR centers, which host roughly 200 surgeons across 10 specialties, adopted “digital asynchronous video for our preoperative workflow” to tackle staffing constraints, missed connections during 8 am to 6 pm calling windows, language barriers, and fragmented education. Gramercy built 2 to 3 minute, actor-led clips that cover preparation, medical and financial clearances, and common billing questions. “The video itself having a human being talk to the patient is what the patient connects with the most,” he said. Videos include closed captions, AI-driven language translation, a brief quiz to reinforce instructions, and embedded calls to action such as “click here to contact our team.” Delivery happens via the electronic health record (EHR) portal and texted links so the content is secure and auditable; per the speaker, the EHR shows message receipt even if the video platform does not track views.

The results, he said, were fewer staff hours needed for preop clearance because the technology “absorbed a certain number of labor hours,” rising video views across nearly 11,000 annual cases, about 1,800 click-throughs to the website or forms, and survey feedback where “95% of our patients have found the video helpful.” Chang added that standardized messaging “clears out all the low-level questions,” so inbound calls are higher value and shorter. He cautioned that automation needs guardrails. If operations change suddenly, teams must “disrupt the automated workflow,” such as pausing routine messages after cancellations.

Hoeft-Hoffman, on the other hand, described moving a six-OR, 24,000-square-foot ASC from postoperative phone calls to two-way texting. The aim was simple, she said: no app downloads, no portal logins, and a flexible vendor “that met our needs.” Daily, a secure patient list triggers a personalized text from “Avery” on the center’s behalf. Nurse-authored replies handle clinical questions, while trigger words such as “bleeding,” “fever,” “dressing,” and “emergency room” escalate messages to desktop alerts. “We were spending approximately 12.5 hours a week on postop calls,” she said, often landing in voicemail. With texting, average response time from nurses is “10 minutes and 41 seconds,” and outbound nursing calls dropped “by 10 hours a week.” Engagement via text holds at roughly 80%, the business office fields fewer calls, and clinical interruptions are minimized because “nurses are no longer pulled away from patients.”

Patients can send photos of dressings, and staff can print clinically relevant images for the record. After-hours texts receive an automated acknowledgment with follow-up when the clinic reopens. For individuals without mobile phones or who prefer calls, the team flags charts for traditional outreach. Hoeft-Hoffman noted many replies are simply “Doing fine, thanks for checking,” which confirms recovery without tying up phone lines. She advised changing culture deliberately: “As with any change, it took the staff a bit to adapt,” but persistence and medical director support helped.

Both speakers addressed compliance. Using the EHR for distribution and documentation supports secure communication, they said, but leaders should still evaluate tracking, third-party data flows, and legal exposure because “there’s definitely a lot of legal concerns to go through.” They also emphasized that automation supplements, not replaces, clinical judgment. “Text messages are not intended to replace all phone calls,” Chang concluded.