Surgery Scheduling: A Piece of the Safe Surgery Puzzle

1. Surgery Scheduling: A Piece of the Safe Surgery Puzzle

2. The Safe Surgery Puzzle

3. The Safe Surgery Puzzle Note: most recent year of data (10/08-10/09)Note: most recent year of data (10/08-10/09)

4. The Safe Surgery Puzzle Time-out

5. The Safe Surgery Puzzle Time-out Cognitive engagement lacking Unclear policies and responsibility Briefing Timing, roles, content, flow Site Marking Timing, roles, verification, placement Scheduling Responsibilities/roles, non-OR procedures, documentation

6. The Safe Surgery Puzzle At least 20 events in 5 years related to scheduling: Across 6 years, 15% of WSS cases indicated OR schedule and consent did not match Staff did not check informed consent before beginning procedure Emergent or ED procedures � sometimes no consent MD/provider determined which procedure was correct, without referring to other documentation Schedule or consent did not include laterality Scheduler assumed order was correct, did not check

7. The Safe Surgery Puzzle Scheduling/Verification Project Surgical Advisory Group Clinical Scheduling Group Combined Discussion

8. Process Gaps/RecommendationsClinic Gap: Staff other than Surgeon/Physician completing key information Recommendation: Surgeon/Physician completes critical scheduling information Procedure Laterality Diagnosis Implants Positioning

9. Process Gaps/RecommendationsClinic Gap: Abbreviations or acronyms misinterpreted Recommendation: Do not use abbreviations or acronyms

10. Process Gaps/RecommendationsClinic Gap: Critical information not completed prior to next patient Recommendation: At minimum, critical information fields completed prior to next patient Surgeon/physician verifies critical components against available source documents, e.g. diagnostic reports, clinic notes.

11. Process Gaps/RecommendationsClinic Gap: Clinic schedule and hospital scheduler do not have redundancies built in at time of scheduling. Recommendation: Send completed surgery request form to hospital scheduler for reference when scheduling with clinic scheduler, or Call hospital scheduler, schedule procedure and fax request form later in the day Hospital scheduler would need to have process to verify scheduled procedure against request form Hospital scheduler performs �read back� of Critical Components to Clinic Scheduler at time of scheduling.

12. Process Gaps/RecommendationsClinic Gap: There is not a standard process for verifying critical components in information sent to patient. Recommendation: Scheduler compares information in patient materials to surgery request form prior to sending. Information to patient includes procedure to be performed along with location/laterality in clinical and laymen terms.

13. Process Gaps/RecommendationsClinic Gap: There is variation in source document requested by, and sent to hospital prior to procedure. Recommendation: Minimum Source Documents: Informed consent and /or physician order with procedure, including laterality/location completed by person performing the procedure. Additional Documents, if available: Diagnostic studies and/or reports Physician note H&P completed by surgeon/person performing the procedure.

14. Process Gaps/RecommendationsClinic Gap: Time and cultural pressures � resistant to changing process Recommendation: Build in �Hard Stops� in the process e.g. procedure not scheduled if critical components not completed by physician Procedure does not move forward at hospital if minimum source documents not received. Need Manager/Administrator Support

15. Hospital Process Scheduling Verification What? Perform a �read back� to clinic scheduler Verify scheduled procedure matches request form when received from clinic Who? Hospital Scheduler Documents Surgery request form Hard Stop Procedure does not move forward if request form not received or verification again form is not completed.

16. Hospital Process Pre-Admission Verification What? Verify required source documents are received prior to procedure � e.g. H&P, pre-op order, diagnostic images/reports Verify that source documents match procedure on schedule and procedure for which patient is being prepped Who? Pre-Op Verification Documents Pre-Op H&P, pre-op order, other source documents such as diagnostic studies Hard Stop Procedure does not move forward if verification is not completed.

17. Hospital Process Pre-Op Verification What? Person completing the procedure information on the informed consent form verifies the patient, procedure and location against source documents. Who? Preferred: person performing the procedure, or Nurse Documents Clinic note or order, path/rad reports, H&P, diagnostic images if available/appropriate, patient understanding of procedure

18. Hospital Process Site Marking What? If surgeon/person performing procedure does not complete informed consent form and verification against source documents, they verify source documents prior to marking procedure site. Who? Surgeon/person performing the procedure Documents Clinic note or order, path/rad reports, H&P, diagnostic images if available/appropriate, patient understanding of procedure Hard Stop Procedure does not move forward until site is signed.

19. Hospital Process Patient Identification What? Verify patient identity upon entering OR/procedure room. Who? Transport/Surgical or Procedure Staff Documents Patient ID Band, Medical Record

20. Hospital Process Time-out What? Verify procedure to be performed matches informed consent and site marking Who? Full surgical/procedure team Documents Informed consent, ACP documentation Hard Stop Procedure does not move forward until discrepancies are resolved.