Preoperative screening program reveals missed diagnoses and reduces mortality
Cancelled surgical procedures at Carilion Roanoke Memorial Hospital (CRMH) in Roanoke, Virginia, are considered a success rather than a failure. “That’s because we cancel procedures for cause,” says Sandy Fogel, MD, FACS. Before 2010, many patients at CRMH were having surgery with undiagnosed, untreated medical problems, and postoperative 30-day mortality…
Fewer surgical cancellations occur after preoperative screening
Duke University Hospital has had a Pre-Operative Screening Unit (POSU) in place for the past 16 years to optimize patients prior to surgery, but until recently, there were no hard data on surgical cancellation rates. Now, a retrospective analysis has revealed that fewer cancellations occur when patients are seen in…
Guidelines addressing preoperative assessment of geriatric patients aim to enhance outcomes
The number of elderly people in the US is on the rise, and so is the number of older patients having surgery. However, while advances in technology and techniques may make surgery more feasible for those age 65 and older, ensuring successful outcomes for this cohort is challenging. Specific guidelines…
Starting in the office to improve postop outcomes
OR teams are accustomed to using checklists to keep patients safe during surgery. Could extending presurgical checklists to the physician’s office or clinic produce even better results? The new Strong for Surgery initiative in Washington State is introducing checklists into offices and clinics to help address issues like nutrition, glycemic…
Editorial
Last month, we wrote about the long history of unnecessary preoperative testing for healthy patients. This month, we’re happy to report that some leading medical societies are publicly calling for physicians and patients to rethink certain kinds of testing. The recommendations are part of the Choosing Wisely campaign, an effort…
Editorial
This month’s article on preop testing research had a familiar ring (page 20). Researchers at the University of Texas Medical Branch (UTMB) in Galveston have found much more testing is being done than seems to be needed. They’re documenting the patterns. Seems not much has changed. These new studies join…
Safer Surgery: The preoperative testing process
Ten elements of safer surgery. The third in a series, this article focuses on presurgical evaluation. Making sure patients have the appropriate preoperative preparation, including testing, is necessary not only for patients’ safe care but also for a smooth process on the day of surgery. Advocate Health Care, a…
Why are there so many unneeded preop tests?
What preoperative tests does your facility require for a healthy 40-year-old having a knee arthroscopy? What about a healthy 82-year-old having an elective procedure? Do these patients need testing at all? A good deal of testing is performed without clinical indications, studies have found. Researchers at the University of Texas…
Safer surgery: Is your scheduling process as accurate is it could be?
Ten elements of safer surgery. Second in a series. Much of the effort to ensure correct-site surgery focuses on preoperative verification. But scheduling is where it all begins. Capturing complete and accurate information when the case is booked is key to preventing errors down the line. Scheduling flaws are…
How should we charge for preadmission testing?
A column on managing the OR revenue cycle. What are the rules for charging for preadmission testing and postop recovery? How should ORs handle charges for a patient who stays in the OR because a postanesthesia care bed is not available? In this column, Keith Siddel, JD, MBA, an…
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