THE DOCTOR IS IN, THE PATIENT IS NOT (The Costs of a Day-of-Surgery Cancellation)

THE DOCTOR IS IN, THE PATIENT IS NOT (The Costs of a Day-of-Surgery Cancellation)

Scene: It’s seven in the morning; operating room 1 is ready; sterile equipment unpackaged and laid per protocol; the surgeon and nurses on stand-by.

The patient: fasted for 8-hours; travelled from some distance with his family, who have taken a day off from work to be with him.

The anesthesiologist: Checks the patient record; cancels surgery.

Another day of surgery cancellation.

The waste, the anxiety, the stress, the disappointment, the blame-game, and negative effect on reputations. It all has a cost but how do you measure the real costs of day-of-surgery (DOS) cancellations?

Surgery cannot proceed when there is a missing pre-surgery lab test, or if medication to manage a pre-existing condition was miscommunicated. The risks are higher if there’s an incomplete picture of the patient’s medical history or current state. A patient that is not pre-optimized through a chain of inefficiencies is dangerous – and costly.

DOS Cancellations Caused by Ineffective Communication

Dr. Gregory Davis of East Carolina Anesthesia Associates explains that day-of-surgery cancellations are still largely caused by an ineffective communication link to the patient prior to surgery. The information needed to make sure that patient is safe for surgery falls through the cracks and the patient shows up with something missing, either a medical record for a prior visit or a test that is needed to be done or shouldn’t. It could also be tests that were done outside approved or recognized medical facilities.

“A patient who has a case cancelled unexpectedly, where it could have been avoided, may be experiencing daily pain, or may have daily functional limitations and is unable to go back to work until this problem is rectified. There maybe psychological factors that are impacting them such as they have a mass and they're worrying if it's benign or malignant and here we are delaying. Then it sets up a whole cascade of effects,” said Davis.

A 2012 study published by the Research Society of Anesthesiology Clinical Pharmacology concluded that most of cancellations of operations are preventable. According to the research, a significant amount of work needs to be undertaken to prepare a patient for a surgical procedure.

Pre-op work ranges from the simple information gathering to active patient monitoring and engagement. According to that study, this range of tasks include the patient notes being written on the day of admission, the consultant taking the time to review the notes, operating theatre staff ensuring the correct surgical instruments are available, ward staff preparing the ward for the patient, secretarial staff preparing theatre lists, the patient preparing self for admission to hospital, and preparations for postoperative care.

According to that study on the "Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital,” cancellation of elective operations is a parameter to assess quality of patient care and quality of management system.

DOS Cancellations Impact Quality Customer Care

“Last minute cancellations result in inefficient use of resources, not in the interests of the patient or the hospital, and result in lost capacity,” said authors Rajender Kumar and Ritika Gandhi as published in the Journal of Anesthesiology Clinical Pharmacology in 2012.

That was six years ago. Today, the world has gone digital. Technology has transformed the ways of doing and communicating. And now it’s healthcare.

As preparing the patient for surgery entails quite a lot, in the emerging era of the bundled healthcare system, a key requirement is a pre-optimized patient.

Bundled care is bringing a value-based healthcare payment model where the total allowable acute and/or post-acute expenditures are predetermined. Healthcare providers then share in any losses or savings that result from the difference of that predetermined price and the actual cost of care, including pre and post op.

So the challenges of pre-optimizing the patient just got all the more crucial. Dr. Perrin Jones, a North Carolina-based anesthesiologist notes that “as healthcare is moving from the traditional volume-based fee for service model fee for value and outcomes, it becomes all the more paramount to deliver effective and efficient care. Whether it’s bundled payment or other types of value-based reimbursement methodology, patient care must be cost-efficient.”

DOS Cancellations Impact More Than Just The Bottom Line

According to Jones, a lot needs to done to optimize the patient as soon as a decision is made to have a surgery, and must be done as quickly as possible. When a patient is not optimized, then that also decreases the likelihood of a good outcome.

“If you don't have a technology platform to be able to implement those different protocols that your practice may have developed, then you really don't have much of a system at all. If you don't have a systematic way to be able to take care of people, things will fall through the cracks,” said Jones.

As early as 2009, researchers at the Tulane University Medical Center had already recommended “that hospitals ensure all patients receive a preoperative visit to verify patients are medically ready for surgery and that they receive the proper preoperative instructions for the day of the procedure.”

That study on the cost of cancelled surgeries in the US was led by Sabrina Bent, MD, MS, clinical associate professor of anesthesiology and director of research at the Tulane University Department of Anesthesia, in New Orleans. “People need to recognize that there is a cost to cancelled surgeries that is not insignificant… The bulk of the cost from cancelled surgery stems from “opportunity costs,” said Bent.

Technology Proven to Increase Doctor Revenue, Improve Patient Care

Technology can now help reduce those pre-operative visits and testing, and ultimately, the total cost of patient care. There are now patient engagement platforms with algorithms for surgical population management, interactive dialogue, collect data and information, and customizable clinical protocols, such as LifeWIRE’s anesthesia protocol.


Anesthesia specialists at ECAA have started using LifeWIRE to seamlessly reach out to a patient that's just been scheduled for surgery, and start a dialogue with them about their health and demographic history. “It will allow us to start gathering information and educate them about the procedure. With the LifeWIRE platform, we are onboarding patient data and automating the process that have otherwise been manually done in the past close the loop of communication within the medical care team,” said Jones.

For ECAA, LifeWIRE decreases the need for additional operative testing by 60-65%. Jones said that from a cost standpoint, on a government-pay-patient that saves about $200 to $250 per patient having surgery, and for a commercial-pay-patient that is about $1,000 per patient.

“So the cost savings with the use of the algorithms used in LifeWIRE will be in the millions of dollars for the healthcare systems that we provide care [for]. It also is decreasing our day of surgery cancellation rate from roughly 18-20 per month to less than one a month,” said Jones.

For the patient going through a perioperative procedure, that means a more polished, efficient and hopefully more patient friendly process. For the healthcare providers, it’s brand reputation – growing a remarkable footprint in their practice.

Aside from a patient perhaps not getting the care they need, one dissatisfied patient likely also creates an angry subset of patients and family members. Both Jones and Davis believe in the need for tools that enhance the communication with patients in preparing for surgery. And that the real cost of day-of-surgery cancellations goes beyond a fixed dollar figure.

After all, there is no price tag for loss of confidence. The ripple effect will only be a cost that health providers pay.

Try LifeWIRE solutions to reduce day of surgery cancellations and improve patient outcomes.



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