Hospitals are constantly looking for new ways to cut costs without compromising care quality. Ever so quick to target the operating room as an area to reduce expenses, hospitals tend to overlook the entire pre-operative patient optimization process in their improvement efforts.
This content is sponsored by Surgical Directions.
The goal of optimizing patients prior to surgery is to prevent postoperative complications, decrease length of stay, reduce unplanned readmissions and enhance the patient's overall health and experience. Hospitals that truly optimize patients prior to surgery stand to gain a great deal in patient satisfaction, patient outcomes and financial reimbursement.
"It's becoming increasingly important for hospitals to invest in their preadmission testing resources to help keep operational costs down while simultaneously improving outcomes. Not only has this helped with coordination and communication, but it has helped our clients capture what used to be missed revenue." said Dhir Desai, associate project manager with Surgical Directions. "If hospitals can optimize patients appropriately, it can really help them get a handle on some of the financial pressures that payers are continuing to put in place."
First things first, it's crucial to outline what optimizing patients involves.
What is optimization and what does it entail?
There are many parts of optimization, but the first is determining — based on what kind of surgery is scheduled — whether the hospital needs to do anything at all to optimize the patient, according to Sunil Eappen, MD, chairman of anesthesiology and the CMO at the Massachusetts Eye and Ear Infirmary in Boston, as well as assistant professor of anesthesiology at Boston's Harvard Medical School.
"That may sound kind of funny, but it's actually a very important question," he says. "If the hospital doesn't do this part properly, it could end up wasting the time of the patients, the energy of the clinicians and the money of the hospital on unnecessary lab tests and screenings."
For instance, research suggests evaluating and optimizing patients who are undergoing eye surgery does not improve outcomes or reduce morbidity for the vast majority of cases.
The second part of optimization is determining the best method to preoperatively screen patients, be it over the phone or as an in-person meeting. According to Dr. Eappen, more and more hospitals are trying to determine the best screening method based on data that already exists from patient-driven portals or provider-conducted interviews.
"The hospitals that optimize patients best are very protocol-driven. They have defined protocols for nearly every different kind of surgery and various patient criteria sets," says Dr. Eappen. "Using the same routines for every patient and giving every patient the same tests isn't efficient. The protocols should be driven by the likelihood of catching a problem that clinicians can act on prior to surgery to reduce the patient's risk."
The third part of optimization is establishing proper coordination between all of the hospital's departments within perioperative services, according to Mr. Desai.
"Coordination should include scheduling, pre-admission testing, nursing and anesthesia," says Mr. Desai. "Coordination is key to really moving the ball forward with optimizing patients appropriately, day by day."
Optimization that falls short: Why it happens and why it's a problem
Lack of coordination and a central command structure surrounding patient optimization drive inefficient and expensive perioperative hospital practices. Bringing all of the necessary stakeholders together on a daily basis can help enhance coordination.
"I have noticed that one area many hospitals trip up on is the daily huddle — too many organizations fail to involve preadmission testing, scheduling and anesthesia," says Mr. Desai. "Not having anesthesia at the table can cause a lot of delays with the clearances between pre-op and the OR."
Alecia Torrance, MSN, BSN, RN, senior vice president of clinical operations and chief nursing executive for Surgical Directions, agrees that an uninvolved anesthesia department is a major problem. According to Ms. Torrance, when anesthesiologists fail to take responsibility for the oversight of the pre-admission testing process and leave it to hospitals without a central command structure, delays are bound to happen.
Including a representative from the materials or supply chain department in the daily huddle can ensure all cases the following day are adequately prepared. Considering the average hospital OR costs $60 to $80 a minute, according to Mr. Desai, this preparation is key to keeping costs in check.
Delays are another major pain point for hospitals. Delays not only cost hospitals financially by compromising reimbursement and revenue, they can prove costly in the area of patient satisfaction, according to Ms. Torrance.
"In a way, going to the hospital for an elective procedure is like going to a restaurant after making a reservation," said Ms. Torrance. "If you get to the restaurant and your table isn't ready, you feel undervalued as a customer. Similarly, if a patient arrives at the hospital on the day of surgery and there are major delays, they feel unimportant and brushed aside."
Getting clinicians and patients on board with improvement efforts
For hospitals that recognize a need to improve their patient optimization practices, it's imperative to engage both the medical staff and patients.
Engaging a hospital's medical staff is critical to sustaining compliance with standardized patient optimization improvement efforts. To engage the staff, hospitals can establish evidence-based protocols, as well as a governance structure or oversight committee. "Clinicians should not only help train and educate hospital administrators on patient optimization processes, they should help lead them throughout the process," said Ms. Torrance.
Ms. Torrance suggests creating a surgical services executive committee. This committee should include staff members at the forefront of care: key surgeons, anesthesia personnel and nursing leaders. Hospital administrators should also be involved. Some hospitals hold "town hall" meetings with the surgical staff and other perioperative players to maintain engagement.
Standardization is another key, according to Dr. Eappen. "Different surgeons and anesthesiologists and perioperative caregivers all have their own way of doing the same procedure, so standardizing optimization protocols is really helpful," he says. "The point is not to handcuff anyone — if there is a good reason for a patient to get tested outside of the standard criteria, that's fine, you should just have to justify it."
Although much of the onus to improve pre-operative optimization falls on the hospital, patients also have a hand in preparing for a surgical procedure. The key is to help patients realize the power they possess, according to Ms. Torrance.
"Patients need to be educated on the appropriate times to show up, medications to take and to avoid before surgery, and whether a preadmission testing department even exits," said Ms. Torrance. "They also need to know when they need to meet with the PAT department. It helps when the PAT department calls patients at home to set up the meeting in a more relaxed environment."
Making surgery completely stress-free for patients may seem like a lofty vision, but hospitals can come closer to realizing it by improving their optimization efforts. Doing so will not only put patients' mind at ease, it has the potential to bolster a hospital's bottom line.